Give me brief information about, brief information about the endometrial cancer.

Reading File

Finding Sources

Searching PubMed

"endometrial cancer"[MeSH Terms] AND diagnosis AND treatment

Reading File

Loading Image

Here is a comprehensive brief overview of endometrial cancer, drawn from authoritative medical textbooks.

Endometrial Cancer

Definition & Epidemiology

Endometrial cancer arises from the inner epithelial lining of the uterus (endometrium) and is the most common gynecologic cancer in women in the United States. It accounts for approximately 67,000 new cases and 13,000 deaths per year, making it the fourth most common cancer in women overall (after breast, lung, and colorectal cancers). Nearly 3% of U.S. women are expected to develop the disease in their lifetime. The average age at diagnosis is 60 years; it is rare before age 45. While it is more common in White women, Black women have a significantly higher mortality rate.

Goldman-Cecil Medicine, p. 2094

Types

Endometrial cancers are broadly divided into two types:

Feature	Type 1	Type 2
Estrogen	Dependent	Independent
Histology	Endometrioid adenocarcinoma	Clear cell or serous carcinoma
Patients	Younger, obese, perimenopausal	Older, thin, postmenopausal
Frequency	80-85%	15-20%
Prognosis	Lower grade, earlier stage	More aggressive, higher mortality
Molecular	ER/PR positive; MSI	TP53 mutations; ERBB2 overexpression

Notably, serous and clear cell types make up less than 10% of cases yet account for more than half of all endometrial cancer deaths.

Berek & Novak's Gynecology, p. 2141

Molecular Classification (TCGA)

Modern molecular classification divides endometrial cancers into four subtypes based on POLE sequencing and immunohistochemistry:

TCGA Molecular Classification of Endometrial Cancer

POLE ultra-mutated (~5%) - best prognosis
MSI hypermutated (~25%) - intermediate prognosis; important for immunotherapy
Copy number low / TP53 wild-type (~40%) - intermediate prognosis
Copy number high / TP53 mutated (~30%) - worst prognosis
Goldman-Cecil Medicine, p. 2094-2095

Risk Factors

The most important risk factor is prolonged unopposed estrogen stimulation. Key risk factors include:

Complex atypical hyperplasia (nearly 30-fold increased risk)
Obesity (increased aromatase activity in adipose tissue converts androgens to estrogen)
Nulliparity
Diabetes mellitus
Early menarche / late menopause
Tamoxifen use
Increasing age
Lynch syndrome (up to 60% lifetime risk for endometrial cancer)
Cowden syndrome (PTEN mutation; 13-20% lifetime risk)
Family history of endometrial cancer (1.5-2x increased risk)

Sporadic cases account for the majority; only 3-5% are attributed to genetic predisposition.

Goldman-Cecil Medicine, p. 2094

Clinical Features

Abnormal uterine bleeding is the hallmark presenting symptom, occurring in about 90% of cases
Postmenopausal bleeding should always raise suspicion
Pelvic pain, palpable uterine mass, or weight loss may be present in advanced disease
Most women present at an early, curable stage due to the prominent bleeding symptom

Diagnosis

Office endometrial aspiration biopsy - the accepted first step in evaluating abnormal uterine bleeding or suspected endometrial pathology
Transvaginal ultrasound - endometrial thickness >4 mm in postmenopausal women warrants further evaluation
Hysteroscopy with directed biopsy - if aspiration biopsy is insufficient or non-diagnostic
No effective screening test exists for the general population

Berek & Novak's Gynecology, p. 2141

Staging (FIGO Surgical Staging)

Staging is surgical and includes hysterectomy, bilateral salpingo-oophorectomy, and peritoneal cytology. Lymph node assessment is required for most patients.

Stage	Description
I	Confined to the uterine corpus
II	Cervical stromal invasion
III	Local/regional spread (adnexa, serosa, vagina, lymph nodes)
IV	Bladder/bowel involvement or distant metastasis

Prognostic Variables

The most important adverse prognostic factors are:

Advancing age
Non-endometrioid or grade 3 histology
Deep myometrial invasion
Lymph-vascular space invasion
Large tumor size
Cervical extension
Lymph node metastasis
Intraperitoneal spread

Treatment

Surgery is the primary treatment for most patients:

Total hysterectomy + bilateral salpingo-oophorectomy + surgical staging

Adjuvant therapy based on risk:

Vaginal vault brachytherapy - for low-to-intermediate risk (reduces vaginal recurrence)
External pelvic radiation - for intermediate to high-risk disease
Chemotherapy (carboplatin + paclitaxel) - for high-risk, advanced, or recurrent disease
Hormonal therapy (progestins) - for low-grade recurrent or metastatic disease
Immunotherapy (pembrolizumab) - particularly effective in MSI-high or mismatch repair-deficient tumors

Radiation alone may be used as primary treatment for patients who are not surgical candidates.

Berek & Novak's Gynecology, pp. 2141-2142

Prognosis

Overall prognosis is generally favorable because most patients (about 75%) present with Stage I disease, which carries a 5-year survival rate exceeding 90%. Advanced-stage and high-grade histologies have significantly worse outcomes.

Sources: Goldman-Cecil Medicine (International Edition) | Berek & Novak's Gynecology

This is a shared conversation. Sign in to Orris to start your own chat.