Endometrial cancer
Endometrial cancer is the most common gynecologic malignancy, most often a type I endometrioid adenocarcinoma driven by unopposed estrogen and heralded by postmenopausal bleeding. Any postmenopausal bleeding or thickened endometrial stripe prompts endometrial biopsy, and early-stage disease is treated with total hysterectomy and bilateral salpingo-oophorectomy, giving a favorable overall prognosis.
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What this article covers
- Overview
Definition: endometrial cancer is a malignancy arising from the glandular lining of the uterus, most often an endometrioid adenocarcinoma that develops after prolonged, unopposed estrogen stimulation of the endometrium.
- Epidemiology
Median age at diagnosis: the average age of women with endometrial cancer is 61 years, so uterine bleeding in this population should be treated as endometrial cancer until proven otherwise.
- Risk factors
Unopposed estrogen exposure: the dominant risk factor for type I disease, whether from endogenous chronic anovulation or exogenous unopposed estrogen therapy.
- Pathophysiology
Type I (endometrioid) pathway: sustained unopposed estrogen drives endometrial gland proliferation that progresses through atypical or complex endometrial hyperplasia, an identifiable intraepithelial…
- Clinical features
Postmenopausal bleeding is the cardinal symptom: the most common presenting symptom, and because type I tumors bleed early, most are detected while still confined to the uterus.
- Differential diagnosis
Endometrial hyperplasia: the premalignant precursor of type I cancer, also presenting with postmenopausal bleeding; distinguished from carcinoma only on histology.
- Diagnosis
Confirmed by tissue: endometrial biopsy showing adenocarcinoma is diagnostic, and disease extent is then established by surgical (not clinical or imaging) staging at hysterectomy, which grades tumors…
- Management
Early-stage type I disease, surgery alone: total hysterectomy with bilateral salpingo-oophorectomy and surgical lymph node assessment is the treatment of choice and, for early-stage, low-grade…
- Complications
Metastatic spread: direct extension to the cervix, adnexa, bladder, or bowel, and distant spread to lung, liver, or bone in advanced disease, driving stage IV mortality.
- Prognosis
Stage predicts survival most strongly: stage I disease carries an 80-90% 5-year overall survival, whereas stage IV disease carries only a 20-30% 5-year overall survival.
- Prevention
Progestin co-administration with any estrogen therapy in a woman with a uterus: cyclic oral progestin (for example medroxyprogesterone acetate 5-10 mg daily for 12-14 days per cycle) or a continuous…
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