Endometrial Cancer

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