Endometrial (Uterine) Cancer
Related Subjects:
|Anatomy of the Uterus
|Anatomy of the Ovary
|Gynaecological History Taking
|Colposcopy
|Premature Menopause
|Polycystic Ovary syndrome
|Endometrial (Uterine) Cancer
🌸 Endometrial cancer (uterine cancer) is the most common gynaecological cancer.
It originates in the endometrium (uterine lining) and most often affects postmenopausal women.
Any postmenopausal bleeding 🚨 should be treated as cancer until proven otherwise.
📖 About
- Arises from the lining of the uterus (endometrium).
- Most common between ages 50–70 👵.
🧬 Aetiology
- 🌸 Prolonged unopposed oestrogen exposure
- 📅 Longer reproductive years (early menarche, late menopause)
- 🚫 Nulliparity (never pregnant)
- ⚖️ Obesity
- 💊 Tamoxifen therapy (for breast cancer)
- 👨👩👧 Family history (colon, ovarian, breast cancer, esp. Lynch syndrome)
- 🍬 Diabetes mellitus
⚠️ Key Risk Factors
- 👵 Age >50 years
- ⚖️ Obesity → ↑ peripheral conversion of androgens to oestrogen
- 💊 Oestrogen-only HRT (without progesterone)
- 🚫 Nulliparity
- 📅 Early menarche & late menopause
- 👨👩👧 Family history of HNPCC/Lynch syndrome
🩺 Clinical Features
- 🚨 Postmenopausal bleeding (red flag)
- 🌸 Intermenstrual bleeding or abnormal discharge
- ❤️ Pelvic pain or dyspareunia (painful intercourse)
- 👐 Palpable pelvic/uterine mass (advanced cases)
🔬 Investigations
- 🧪 Bloods: FBC, U&E, LFTs, CRP
- 🖥️ Transvaginal ultrasound (TVUS): Endometrial thickness >4mm in postmenopausal women → concerning
- 🔎 Hysteroscopy + biopsy: Gold standard
- 🧴 Dilation & curettage (D&C) for histology
- 🖼️ Imaging:
- MRI pelvis → staging depth of invasion
- CT CAP → staging for advanced or aggressive histology
📊 FIGO Staging
- Stage I: Confined to uterus
- Stage II: Invades cervix
- Stage III: Beyond uterus → pelvis/lymph nodes
- Stage IV: Beyond pelvis → bladder, rectum, distant mets
💊 Management
- 🔹 Stage I–II: Total hysterectomy + bilateral salpingo-oophorectomy (HYST-BSO) ± lymph node sampling
- 🔹 Stage III: Surgery ± radiotherapy/chemotherapy depending on nodal spread
- 🔹 Stage IV: Palliative – hormonal therapy (progestins), radiotherapy, supportive care
- 🌸 Adjuvant: Radiotherapy or chemotherapy in high-risk histology (serous/clear cell)
- 💊 Hormonal therapy: Progestins for palliation or fertility-preserving management in young women
📚 Teaching Pearls
- 🚨 Postmenopausal bleeding = cancer until proven otherwise
- ⚖️ Obesity is the strongest modifiable risk factor
- 🖥️ TVUS: Endometrial thickness cutoff = 4mm
- 💊 Tamoxifen paradox: breast cancer protection but ↑ risk of endometrial carcinoma
- 🧬 Lynch syndrome → 40% lifetime risk of endometrial cancer
