Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 18-21: Carcinoma of the Endometrium + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Abnormal uterine bleeding is the presenting sign in 90% of cases Papanicolaou smear is frequently negative After a negative pregnancy test, endometrial tissue is required to confirm the diagnosis +++ General Considerations ++ Adenocarcinoma of the endometrium is the second most common cancer of the female genital tract Occurs most often in women 50–70 years of age Risk factors Obesity Nulliparity Diabetes mellitus Polycystic ovaries with prolonged anovulation Unopposed estrogen therapy Extended use of tamoxifen for the treatment of breast cancer Women with a family history of colon cancer (hereditary nonpolyposis colorectal cancer, Lynch syndrome) are at significantly increased risk, with a lifetime incidence as high as 30% + Clinical Findings Download Section PDF Listen +++ ++ Abnormal uterine bleeding is the presenting sign in 90% of cases Any postmenopausal bleeding requires investigation Pain generally occurs late in the disease, with metastases or infection + Diagnosis Download Section PDF Listen +++ ++ Papanicolaou smears of the cervix Occasionally show atypical endometrial cells However, they are an insensitive diagnostic tool Endocervical and endometrial sampling is the only reliable means of diagnosis Simultaneous hysteroscopy can be a valuable addition in order to localize polyps or other lesions within the uterine cavity Pelvic ultrasonography may be used to determine the thickness of the endometrium as an indication of hypertrophy and possible neoplastic change + Treatment Download Section PDF Listen +++ ++ Total hysterectomy and bilateral salpingo-oophorectomy Peritoneal washings for cytologic examination are routinely taken and lymph node sampling may be done Women with high-risk endometrial cancer (serous adenocarcinoma, clear cell carcinoma, grade 3 deeply invasive endometrioid carcinoma, and stages III/IV disease) are generally treated with surgery followed by chemotherapy and/or radiation therapy + Outcome Download Section PDF Listen +++ +++ Prognosis ++ With early diagnosis and treatment, the overall 5-year survival is 80–85% With stage I disease, the depth of myometrial invasion is the strongest predictor of survival, with a 5-year survival of 98% with a less than 66% depth of myometrial invasion 78% with a 66% or greater depth of myometrial invasion +++ When to Refer ++ All patients should be referred to a gynecologic oncologist + References Download Section PDF Listen +++ + +Bodurtha Smith AJ et al. Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 May;216(5):459–76. [PubMed: 27871836] + +McDonald ME et al. Endometrial cancer: obesity, genetics and targeted agents. Obstet Gynecol Clin North Am. 2019 Mar;46(1):89–105. [PubMed: 30683268] + +Passarello K et al. Endometrial cancer: an overview of pathophysiology, management and care. Semin Oncol Nurs. 2019 Apr;35(2):157–65. [PubMed: 30867105] + +Visser NCM et al. Accuracy of endometrial sampling in endometrial carcinoma: a systematic review and meta-analysis. Obstet Gynecol. 2017 Oct;130(4):803–13. [PubMed: 28885397]