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For further information, see CMDT Part 18-21: Carcinoma of the Endometrium

Key Features

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

  • 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

  • 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

  • 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

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

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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]
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McDonald  ME  et al. Endometrial cancer: obesity, genetics and targeted agents. Obstet Gynecol Clin North Am. 2019 Mar;46(1):89–105.
[PubMed: 30683268]
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Passarello  K  et al. Endometrial cancer: an overview of pathophysiology, management and care. Semin Oncol Nurs. 2019 Apr;35(2):157–65.
[PubMed: 30867105]
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Visser  NCM  et al. Accuracy of endometrial ...

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