Endometrial Cancer

Specialties > Cancer

Background knowledge 🧠

Definition

Endometrial cancer is a malignancy originating from the endometrial lining of the uterus.
It is the most common gynaecological cancer in developed countries.
Primarily affects postmenopausal women.
Two main types: Type 1 (oestrogen-dependent) and Type 2 (non-oestrogen-dependent).

Epidemiology

Most common gynaecologic malignancy in the UK.
Incidence increases with age, peaking between 60-70 years.
Higher prevalence in obese women and those with metabolic syndrome.
Lower incidence in women with a history of long-term oral contraceptive use.
Approximately 9,000 new cases per year in the UK.

Aetiology and Pathophysiology

Risk factors include obesity, unopposed oestrogen therapy, polycystic ovarian syndrome (PCOS), and diabetes.
Genetic factors: Lynch syndrome, Cowden syndrome.
Hyperplasia with atypia can progress to endometrial carcinoma.
Type 1: Associated with oestrogen excess, usually low-grade.
Type 2: Not associated with oestrogen, typically high-grade and aggressive.

Types

Type 1: Endometrioid adenocarcinoma, most common, better prognosis.
Type 2: Serous, clear cell, and carcinosarcoma, poorer prognosis.
Other rare types: Mucinous, squamous, mixed cell adenocarcinoma.
Type 2 is more likely to spread beyond the uterus at diagnosis.
Histological grading from Grade 1 (well-differentiated) to Grade 3 (poorly differentiated).

Clinical Features 🌡️

Symptoms

Postmenopausal bleeding is the most common symptom.
Premenopausal women may present with irregular or heavy menstrual bleeding.
Pelvic pain or discomfort.
Discharge that is not blood-stained can also occur.
Advanced disease may present with lower abdominal pain or weight loss.

Signs

Enlarged, tender uterus on bimanual examination.
Visible lesion on the cervix or vaginal vault in advanced cases.
May present with ascites in advanced disease.
Signs of metastasis may include lymphadenopathy or pleural effusion.
Cachexia in very advanced disease.

Investigations 🧪

Investigations

Transvaginal ultrasound to assess endometrial thickness.
Endometrial biopsy or hysteroscopy for histological diagnosis.
MRI and CT scans for staging and detecting metastasis.
CA-125 may be elevated in advanced disease.
Blood tests including full blood count, liver function tests.

Management 🥼

Management

Surgical treatment: Total hysterectomy with bilateral salpingo-oophorectomy.
Lymph node dissection in high-risk cases.
Adjuvant radiotherapy for high-risk or advanced-stage disease.
Chemotherapy for advanced or recurrent disease.
Hormonal therapy (e.g., progestins) for metastatic or recurrent hormone receptor-positive cancers.
Follow-up: Regular surveillance with pelvic exams and imaging.

Complications

Local recurrence in the pelvis.
Metastasis to distant organs (lungs, liver, bones).
Side effects of treatment (e.g., lymphedema, radiation cystitis).
Complications of surgery (e.g., infection, bleeding).
Psychological impact of diagnosis and treatment.

Prognosis

Early-stage disease has a good prognosis with high cure rates.
Five-year survival rates for stage I is approximately 80-90%.
Prognosis worsens with advanced-stage disease.
Regular follow-up is essential for early detection of recurrence.
Overall survival depends on stage at diagnosis, treatment response, and patient factors.

Key Points

Endometrial cancer is the most common gynaecological cancer in developed countries.
Early detection and treatment are key to favourable outcomes.
Management includes surgical, radiotherapeutic, and chemotherapeutic options.
Follow-up care is essential to monitor for recurrence and manage complications.
Prevention strategies include managing risk factors such as obesity and unopposed oestrogen therapy.

References/Further Reading

NICE guidelines on endometrial cancer management.
British Journal of Obstetrics and Gynaecology articles.
Clinical Gynecologic Oncology by DiSaia and Creasman.
Journal of Clinical Oncology articles on endometrial cancer.
UpToDate: Endometrial cancer overview and management.
British Gynaecological Cancer Society guidelines.

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