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Endometrial cancer

Last reviewed: 23 Oct 2024
Last updated: 07 Jun 2024

Summary

Definition

History and exam

Key diagnostic factors

  • postmenopausal vaginal bleeding (PVB)
Full details

Other diagnostic factors

  • uterine mass, fixed uterus, or adnexal mass indicating extrauterine disease
  • abnormal menstruation or vaginal bleeding in a premenopausal woman
  • pain (abdominal or pelvic) and weight loss
  • symptoms of metastatic disease
  • signs of metastatic disease
Full details

Risk factors

  • overweight and obesity
  • age >50 years
  • endometrial hyperplasia
  • unopposed endogenous estrogen
  • unopposed exogenous estrogen
  • tamoxifen use (postmenopausal women)
  • insulin resistance
  • family history of endometrial or colorectal cancer
  • family history of breast cancer or ovarian cancer
  • family history of Lynch syndrome (hereditary nonpolyposis colorectal cancer)
  • family history of PTEN syndromes
  • polycystic ovary syndrome
  • radiation therapy
  • inactivity
  • diet
  • nulliparity and infertility
Full details

Diagnostic tests

1st tests to order

  • pelvic (transvaginal) ultrasound
  • office-based endometrial biopsy (with or without office-based hysteroscopy) and histopathology
  • hysteroscopy, dilation and curettage (D&C), and histopathology
  • Cervical cytology (Pap smear or liquid-based cytology)
  • CBC
Full details

Tests to consider

  • Molecular and genetic analysis
  • serum CA-125 level
  • saline infusion sonohysterogram
  • BUN and creatinine (renal function testing)
  • LFTs
  • chest x-ray
  • CT scan of chest, abdomen, and pelvis
  • MRI of uterus, pelvis, and abdomen
  • PET/CT scan
Full details

Treatment algorithm

ACUTE

stage IA endometrioid carcinoma not considering fertility preservation

stage IA endometrioid carcinoma considering fertility preservation

stage IB or II endometrioid carcinoma

stages III to IV endometrioid carcinoma; all nonendometrioid carcinomas (high risk)

ONGOING

recurrent or incurable disease

Contributors

Authors

Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Alexander B. Olawaiye

Associate Professor

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology, and Reproductive Sciences

Magee-Womens Hospital of UPMC

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.

Richard T. Penson, MD, MRCP
Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

RTP declares that his institution has received research funding from Array BioPharma Inc., AstraZeneca, Genentech, and Vascular Biogenics Ltd on his behalf. RTP has received research funding from Genentech Inc., ImClone Systems Inc., Endocyte Inc., AstraZeneca, Eisai Inc., Amgen Inc., and Vascular Biogenics Ltd. He has been paid for participating in scientific advisory boards for AbbVie, AstraZeneca, Baxalta Oncology, Clovis Oncology, Curio Science, Eisai Inc., Endocyte Inc., Genentech, Janssen Oncology (J&J), Merck & Co., Mersana Therapeutics Inc., NewLink Genetics, Nexus Global Group, Pieris Pharma Inc., Roche Inc., Sutro Biopharma, Syndax Pharmaceuticals, Tesaro Inc., and Vascular Biogenics Ltd. RTP was an expert witness for Aventis Pharma S.A. vs. Apotex Inc. in 2009. RTP has received royalties from: BMJ, Blackwell Publishing Medicine at a glance, and UpToDate Advance Medical: Second Medical Opinion.

Acknowledgements

Dr Alexander B. Olawaiye and Dr Richard T. Penson would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who has sadly died, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.

Disclosures

NSH and AHR declare that they have no competing interests.

Peer reviewers

Susan A. Davidson, MD

Associate Professor/Chief

Gynecologic Oncology

S/M Obstetrics & Gynecology (UCD)

University of Colorado Health Sciences Center

Aurora

CO

Disclosures

SAD declares that she has no competing interests.

Svetlana Mironov, MD

Attending Radiologist

Assistant Professor of Radiology

Memorial Sloan-Kettering Cancer Center

New York

NY

Disclosures

SM declares that she has no competing interests.

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