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| Endometrial cancer is the cancer of the uterine corpus. There are multiple histological types, but the most common is the endometroid carcinoma. It’s mostly a disease of postmenopausal women. | | {{#lst:Endometrial cancer|gynaecology1}} |
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| It’s the most common form of gynaecological cancer (but not the most deadly, ovarian cancer is). It causes symptoms early, enabling diagnosis at a stage where there is a high likelihood of cure. The mortality is relatively low.
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| == Pathological classification ==
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| These are most common histological types:
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| * Endometrioid type (80%)
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| * Non-endometrioid type
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| ** Serous adenocarcinoma
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| ** Clear cell carcinoma
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| ** Mucinous adenocarcinoma
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| ** +++
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| However, we can also distinguish two types based on the incidence, responsiveness to hormones, and clinical behaviour:
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| * Type I tumours – 80% of cases
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| ** Endometrioid carcinoma grade 1
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| ** Endometrioid carcinoma grade 2
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| * Type II tumours
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| ** Endometrioid carcinoma grade 3
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| ** Non-endometrioid carcinomas
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| Compared to type II tumours, type I tumours have a favourable prognosis, are oestrogen-induced, responsive to progestins, and may be preceded by an intraepithelial neoplasm.
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| == Etiology ==
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| The risk factors for type I and type II are different. Type I is generally related to increased unopposed oestrogen exposure, while type II is unrelated to oestrogen:
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| * Type I tumours
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| ** Obesity
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| ** Unopposed oestrogen therapy
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| ** Tamoxifen
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| ** PCOS
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| ** Early menarche
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| ** Late menopause
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| * Type II tumours
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| ** Old age
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| ** Low BMI
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| ** Non-white ethnicity
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| == Clinical features ==
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| The characteristic symptom is abnormal uterine bleeding, which is the presenting complaint in almost all cases. There is often metrorrhagia or hypermenorrhoea.
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| == Diagnosis and evaluation ==
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| As always, history and physical examination is important. History should evaluate if the patient has received unopposed oestrogen therapy, if there is family history of gynaecological cancer, etc. Physical examination should include a conventional gynaecological exam, as well as a rectovaginal examination, to assess the rectovaginal septum. This can give information on whether the cancer has spread regionally.
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| Imaging is important. Transvaginal ultrasound can be used to evaluate the endometrial thickness. A thickness of ≤4 mm in postmenopausal women means a very low risk for endometrial cancer.
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| Endometrial carcinoma is a histological diagnosis based on an endometrial biopsy, curettage sample, or hysterectomy specimen. The endometrial biopsy may be blind or guided by hysteroscopy.
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| == Staging ==
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| MRi or CT is important in staging the tumour, to evaluate the local and distant spread. The complete staging can only be performed after total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy.
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| [[Category:Obstetrics and gynaecology 2]] | | [[Category:Obstetrics and gynaecology 2]] |
