Endometrial Cancer

WHAT IS IT?

Endometrial cancer is a gynecological malignancy that involves the endometrium of the uterus. It is believed that estrogen signaling in the uterus (especially unopposed by progesterone) is a cause of endometrial cancer. This malignancy can progress form endometrial hyperplasia, but can also be sporadic. Adenocarcinoma is the most common type of endometrial cancer.

Endometrial cancer schematic (source)
Endometrial cancer schematic (source)
WHY IS IT A PROBLEM?

Endometrial cancer can be an aggressive disease that progresses rapidly.

WHAT MAKES US SUSPECT IT?

Risk factors: Lynch syndrome (HNPCC), tamoxifen usage, polycystic ovarian syndrome, estrogen usage, early menarche/late menopause, nulliparity, infertility with anovulatory cycles, and obesity.

Abnormal vaginal bleeding is a common presentation that can include post menopausal bleeding (PMB) 

Other symptoms can include:

  • Abdominal/pelvic pain
  • Abdominal bloating/distention
  • Changes in bowel/bladder function
HOW DO WE CONFIRM A DIAGNOSIS?

Endometrial biopsy is eventually needed to confirm suspicions of endometrial cancer. Cancers derived form hyperplasia are endometrioid in appearance (endometrium-like) while sporadic cancers are often serous and is characterized by papillary structures with psammoma body formation.

Histological analysis of this biopsy of endometrial cancer shows a characteristic glandular pattern that is typical of adenocarcinoma (source)
Histological analysis of this biopsy of endometrial cancer shows a characteristic glandular pattern that is typical of adenocarcinoma (source)
HOW DO WE TREAT IT? 

Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the usual primary treatment

HOW WELL DO THE PATIENTS DO?

This is a potentially life threatening condition. Patients have a better prognosis the earlier this disease is diagnosed.

WAS THERE A WAY TO PREVENT IT?

Oral contraceptives can be protective against endometrial cancer.

WHAT ELSE ARE WE WORRIED ABOUT?

Metastasis/spread of the disease is a concern.

OTHER HY FACTS?

Endometrial cancer is the most common gynecological malignancy in the US

p53 mutations are common in sporadic endometrial cancers

FURTHER READING

DynaMed

UpToDate

 

Page Updated: 06.18.2016