Endometrial cancer

Endometrial Cancer
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Pie chart of relative incidences of endometrial carcinoma

Histopathology of serous carcinoma of uterus

Histopathology of endometrial cancer with lymphovascular invasion

Endometrial cancer is a malignant tumor originating from the epithelial cells of the endometrium, which is the innermost lining layer of the uterus. As one of the most commonly diagnosed gynecological malignancies, especially in developed countries, understanding its etiology, clinical presentation, and management is pivotal for medical professionals, particularly those specializing in gynecologic oncology.

Epidemiology

Endometrial cancer holds the position as the most frequently diagnosed gynecologic cancer in the United States, with annual estimates exceeding 35,000 cases. The majority of these cases are found in post-menopausal women, although younger women are not exempt from this diagnosis.

Pathophysiology

The development of endometrial cancer is often linked to prolonged exposure to unopposed estrogen. This hormonal imbalance leads to endometrial hyperplasia, a precursor to endometrial cancer. Several conditions, such as polycystic ovarian syndrome (PCOS), obesity, and estrogen-secreting tumors can elevate estrogen levels in the body.

Clinical Presentation

Most women present with abnormal vaginal bleeding, often post-menopausal. However, younger women may experience irregular menstrual periods or bleeding between cycles. Additionally, pelvic pain, pain during intercourse, and an enlarged uterus can also be indicative signs.

Diagnosis

The diagnostic gold standard is an endometrial biopsy, which allows for histological examination of the endometrial tissue. If malignancy is suspected, further imaging, including a transvaginal ultrasound, may be warranted to assess the tumor's size and possible invasion into surrounding structures.

Treatment

Early detection of endometrial cancer typically results in favorable outcomes, with a variety of treatment options available:

• Surgery: Hysterectomy, often with bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), is commonly performed. Lymph nodes may also be removed to check for metastatic spread.
• Radiation Therapy: Used post-operatively, or in patients unfit for surgery.
• Chemotherapy: Employed for advanced or recurrent cases.
• Hormone Therapy: Used especially for patients with hormone-receptor positive tumors.

Prognosis

Owing to the characteristic presentation of abnormal bleeding in its early stages, many cases of endometrial cancer are diagnosed promptly, leading to a generally favorable prognosis. The survival rates are significantly higher for endometrial cancer compared to other gynecologic cancers when detected early.

Summary

For medical students, understanding the complexities of endometrial cancer, from its pathophysiology to its management, is crucial. Given its prevalence, clinicians are likely to encounter patients with this diagnosis, necessitating a thorough and compassionate approach to care.

External Links

• National Cancer Institute: Endometrial Cancer Treatment
• Mayo Clinic: Endometrial cancer

Endometrial cancer Resources
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