Related Subjects:
|Anatomy of the Uterus
|Anatomy of the Ovary
|Gynaecological History Taking
|Colposcopy
|Premature Menopause
|Polycystic Ovary syndrome
|Endometrial (Uterine) Cancer
๐ธ Endometrial cancer (uterine cancer) is the most common gynaecological cancer.
It originates in the endometrium (uterine lining) and most often affects postmenopausal women.
Any postmenopausal bleeding ๐จ should be treated as cancer until proven otherwise.
๐ About
- Arises from the lining of the uterus (endometrium).
- Most common between ages 50โ70 ๐ต.
๐งฌ Aetiology
- ๐ธ Prolonged unopposed oestrogen exposure
- ๐
Longer reproductive years (early menarche, late menopause)
- ๐ซ Nulliparity (never pregnant)
- โ๏ธ Obesity
- ๐ Tamoxifen therapy (for breast cancer)
- ๐จโ๐ฉโ๐ง Family history (colon, ovarian, breast cancer, esp. Lynch syndrome)
- ๐ฌ Diabetes mellitus
โ ๏ธ Key Risk Factors
- ๐ต Age >50 years
- โ๏ธ Obesity โ โ peripheral conversion of androgens to oestrogen
- ๐ Oestrogen-only HRT (without progesterone)
- ๐ซ Nulliparity
- ๐
Early menarche & late menopause
- ๐จโ๐ฉโ๐ง Family history of HNPCC/Lynch syndrome
๐ฉบ Clinical Features
- ๐จ Postmenopausal bleeding (red flag)
- ๐ธ Intermenstrual bleeding or abnormal discharge
- โค๏ธ Pelvic pain or dyspareunia (painful intercourse)
- ๐ Palpable pelvic/uterine mass (advanced cases)
๐ฌ Investigations
- ๐งช Bloods: FBC, U&E, LFTs, CRP
- ๐ฅ๏ธ Transvaginal ultrasound (TVUS): Endometrial thickness >4mm in postmenopausal women โ concerning
- ๐ Hysteroscopy + biopsy: Gold standard
- ๐งด Dilation & curettage (D&C) for histology
- ๐ผ๏ธ Imaging:
- MRI pelvis โ staging depth of invasion
- CT CAP โ staging for advanced or aggressive histology
๐ FIGO Staging
- Stage I: Confined to uterus
- Stage II: Invades cervix
- Stage III: Beyond uterus โ pelvis/lymph nodes
- Stage IV: Beyond pelvis โ bladder, rectum, distant mets
๐ Management
- ๐น Stage IโII: Total hysterectomy + bilateral salpingo-oophorectomy (HYST-BSO) ยฑ lymph node sampling
- ๐น Stage III: Surgery ยฑ radiotherapy/chemotherapy depending on nodal spread
- ๐น Stage IV: Palliative โ hormonal therapy (progestins), radiotherapy, supportive care
- ๐ธ Adjuvant: Radiotherapy or chemotherapy in high-risk histology (serous/clear cell)
- ๐ Hormonal therapy: Progestins for palliation or fertility-preserving management in young women
๐ Teaching Pearls
- ๐จ Postmenopausal bleeding = cancer until proven otherwise
- โ๏ธ Obesity is the strongest modifiable risk factor
- ๐ฅ๏ธ TVUS: Endometrial thickness cutoff = 4mm
- ๐ Tamoxifen paradox: breast cancer protection but โ risk of endometrial carcinoma
- ๐งฌ Lynch syndrome โ 40% lifetime risk of endometrial cancer