Endometrial cancer is a common malignancy, usually an adenocarcinoma.
Obesity and being overweight are associated with an increased incidence and poorer outcome.
Patients typically present with postmenopausal vaginal bleeding and often have surgically curable disease.
Diagnosis is confirmed by biopsy, or dilation and curettage; staging and histology is confirmed at surgery.
Determining Lynch syndrome status (microsatellite instability-high [MSI-H]/mismatch repair [MMR] protein expression) in women with a significant relevant family history can enable surgical prevention of a subset of endometrial cancers. Patients with these tumors are candidates for immunotherapy.
Adjuvant vaginal brachytherapy and pelvic external beam radiation therapy can reduce local recurrence and improve progression-free survival, but do not improve survival in stages I and II disease.
Chemotherapy and chemoradiotherapy are options for patients with stages III and IV disease at presentation. Hormonal treatment and chemotherapy offers palliation in patients with recurrent disease and nonendometrioid carcinomas (e.g., serous, clear-cell, undifferentiated carcinoma, carcinosarcoma).
An epithelial malignancy of the uterine corpus mucosa, usually an adenocarcinoma.
History and exam
Key diagnostic factors
- postmenopausal vaginal bleeding (PVB)
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
- overweight and obesity
- age >50 years
- endometrial hyperplasia
- unopposed endogenous estrogen
- unopposed exogenous estrogen
- tamoxifen use (postmenopausal women)
- insulin resistance
- family history of endometrial 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
- nulliparity and infertility
1st investigations 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
- Pap smear
Investigations to consider
- serum CA-125 level
- saline infusion sonohysterogram
- BUN and creatinine (renal function testing)
- chest x-ray
- CT scan of chest, abdomen, and pelvis
- MRI of uterus, pelvis, and abdomen
- PET/CT scan
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)
recurrent or incurable disease
Alexander B. Olawaiye, MD, MRCOG, FACOG, FACS
Division of Gynecologic Oncology
Department of Obstetrics, Gynecology, and Reproductive Sciences
Magee-Womens Hospital of UPMC
University of Pittsburgh School of Medicine
ABO is on the scientific advisory board for AstraZeneca, GlaxoSmithKline, Clovis, and Genentech.
Richard T. Penson, MD, MRCP
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
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.
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.
NSH and AHR declare that they have no competing interests.
Susan A. Davidson, MD
S/M Obstetrics & Gynecology (UCD)
University of Colorado Health Sciences Center
SAD declares that she has no competing interests.
Svetlana Mironov, MD
Assistant Professor of Radiology
Memorial Sloan-Kettering Cancer Center
SM declares that she has no competing interests.
- Endometrial hyperplasia
- Endometrial polyp
- Endometrial cancer
- Radiation therapy for endometrial cancer
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