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Updated: Dec 27 2021

Endometrial Cancer

Images
https://upload.medbullets.com/topic/120457/images/endometrialca.jpg
https://upload.medbullets.com/topic/120457/images/endometrial_hyperplasia.jpg
https://upload.medbullets.com/topic/120457/images/endometrial_hyperplasia_2.jpg
  • Snapshot
    • A 72-year-old woman presents to her gynecologist for vaginal bleeding. She denies any vaginal pain or trauma and is not on any medications. A transvaginal ultrasound is performed, which demonstrates endometrial thickening of 6 mm. She underdgoes an endometrial biopsy, which is consistent with endometrial cancer.
  • Introduction
    • Overview
      • malignancy affecting the endometrium of the uterus
  • Epidemiology
    • Incidence
      • most commonly affects women > 40 years of age
    • Risk factors
      • elevated estrogen exposure
        • unopposed estrogen use
        • polycystic ovarian syndrome
        • early menarche
        • estrogen producing tumor
      • obesity
      • nulliparity or history of infertility
      • longterm tamoxifen use
      • Lynch syndrome
      • family history
  • ETIOLOGY
    • Pathophysiology
      • estrogen acts on estrogen receptors in the endometrium, promoting endometrial proliferation and increasing the risk of cancer development
        • normally progesterone inhibits proliferation of the endometrium, thus abnormalities in progesterone lead to unopposed endometrial proliferation
    • Associated conditions
      • cervical adenocarcinoma
      • primary or ovarian cancer
  • Presentation
    • Symptoms
      • abnormal uterine bleeding
        • postmenopause
          • any bleeding
        • 45 to menopause
          • frequent, heavy, or prolonged bleeding
        • < 45 years of age
          • persistent bleeding
            • concerning in patients with risk factors (e.g., chronic anovulation and obesity)
  • Imaging
    • Transvaginal ultrasound
      • indication
        • an alternative to endometrial biopsy in patients who cannot tolerate the in office procedure
          • determines endometrial thickness
    • Hysteroscopy
      • indication
        • performed with dilation and curettage (D&C) in cases where transvaginal ultrasound and endometrial biopsy is unremarkable
  • Studies
    • Invasive studies
      • endometrial biopsy
        • indication
          • first-line in evaluating the endometrium for endometrial hyperplasia or endometrial cancer
  • Differential
    • Uterine leiomyoma
      • differentiating factors
        • enlarged smooth muscle tumor
    • Adenomyosis
      • differentiating factors
        • endometrial gland and stroma in the myometrium
  • Treatment
    • Treatment depends whether the tumor is confined to the uterus or has metastasized
      • treatment involves surgery with or without chemotherapy, hormonal therapy, and radiation
    • Medical
      • progestine therapy
        • indication
          • endometrial cancer confined to the uterus in women who want to preserve fertility
    • Surgical
      • total hysterectomy and bilateral salpingo-oophorectomy
        • indication
          • initial management for endometrial cancer
            • along with pelvic and para-aortic lymphadenectomy
            • also collecting peritoneal fluid for cytology
  • Complications
    • Anemia
    • Metastasis
  • Prognosis
    • Prognostic factors
      • improved
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