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Endometrial cancer

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Evidence last reviewed: 20 Sep 2026
Topic last updated: 16 Oct 2026
07 Jul 2026

US guidance encourages prompt diagnosis and treatment of patients with endometrial cancer.

Updated American College of Obstetricians and Gynecologists (ACOG) guidelines recommend endometrial tissue sampling in combination with transvaginal ultrasound for the initial evaluation of most women who present with postmenopausal bleeding.[103]

Several factors have prompted the implementation of a more stringent triage strategy, including an increased prevalence of endometrial cancer among the US population, a disproportionate rise in endometrial cancer incidence and mortality among non-Hispanic black women compared with white women, and a recognition that transvaginal ultrasonography may be technically less effective than previously thought.[103]

Transvaginal ultrasonography may be used without endometrial biopsy during initial evaluation of select patients when all of the following are present:

  • a single episode of postmenopausal bleeding, and

  • an endometrial thickness of 4 mm or less, and

  • no risk factors strongly associated with malignancy, such as obesity, unopposed estrogen, and a family history of endometrial cancer, and

  • access to prompt gynecologic care and follow-up.

Ver Diagnóstico: abordagem

Fonte original da atualização

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • postmenopausal vaginal bleeding (PVB)
Detalhes completos

Outros fatores diagnósticos

  • 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
Detalhes completos

Fatores de risco

  • 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
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 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 (liquid-based cytology or Pap smear)
  • CBC
Detalhes completos

Investigações a serem consideradas

  • tumor molecular analysis
  • genetic evaluation
  • 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
Detalhes completos

Algoritmo de tratamento

AGUDA

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)

CONTÍNUA

recurrent or incurable disease

Colaboradores

Autores

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

Declarações

ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Corcept, Merck, Eisai, Daiichi Sankyo, and Eli Lilly.

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

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital

Boston, MA

Declarações

RTP declares personal fees for advisory boards from Aadi Bioscience, AstraZeneca, GSK Inc., ImmunoGen Inc., Merck & Co., Roche Pharma, Sutro Biopharma, and Tubulis GmbH. RTP serves on data and safety monitoring boards for AstraZeneca, EQRx, and Roche Pharma. RTP has received institutional research funding as Principal Investigator for 858 Therapeutics. RTP has received royalties from BMJ Publishing, UptoDate, Elsevier Ltd., Wolters Kluwer Health, and Wiley Blackwell. RTP has received payment for educational events: Research to Practice, ExpertConnect, ReachMD, and CMEO Outfitters.

Agradecimentos

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.

Declarações

NSH and AHR declare that they have no competing interests.

Revisores

Susan A. Davidson, MD

Associate Professor/Chief

Gynecologic Oncology

S/M Obstetrics & Gynecology (UCD)

University of Colorado Health Sciences Center

Aurora, CO

Declarações

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

Declarações

SM declares that she has no competing interests.

Créditos aos pareceristas

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Referências

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Principais artigos

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: uterine neoplasms [internet publication].Texto completo

Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021 Jan;31(1):12-39.Texto completo  Resumo

Oaknin A, Bosse TJ, Creutzberg CL, et al. Endometrial cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022 Sep;33(9):860-77.Texto completo  Resumo

Amant F, Mirza MR, Koskas M, et al. Cancer of the corpus uteri. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:37-50.Texto completo  Resumo

American College of Obstetricians and Gynecologists; Society of Gynecologic Oncology. Practice bulletin no. 149: endometrial cancer. Apr 2015 [internet publication].Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Endometrial cancer images

  • Diagnósticos diferenciais

    • Endometrial hyperplasia
    • Endometrial polyp
    • Endometriosis
    Mais Diagnósticos diferenciais

  • Diretrizes

    • Pain management for in-office uterine and cervical procedures
    • Fertility preservation in people with cancer: ASCO guideline update
    Mais Diretrizes

  • Folhetos informativos para os pacientes

    Hysterectomy

    Mais Folhetos informativos para os pacientes
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