• Clinical science

Endometrial cancer

Summary

Endometrial cancer is the most common cancer of the female genital tract in the US, with a peak incidence between 60 and 70 years of age. Endometrial cancers can be divided into two types based on histological characteristics; type I cancers account for 75% of all endometrial cancers and are of endometrioid origin, while type II cancers originate from serous or clear cells. Several risk factors are associated with the development of endometrial cancer, of which the most important is long-term exposure to increased estrogen levels, especially in type I cancer. The main symptom is often painless, vaginal bleeding, which presents at an early stage. Later stages may manifest with pelvic pain and a palpable mass, whereby pelvic exams are often normal. The diagnosis is made primarily via an endometrial biopsy, which shows endometrial hyperplasia and atypical cells. Additional imaging studies (e.g., ultrasonography, abdominal CT, X-ray) are usually required for the detection and staging of metastases. Treatment of early-stage endometrial cancer involves hysterectomy with adnexectomy and may also require additional lymph node removal. Radical hysterectomy according to the Wertheim-Meigs method is performed in cases of advanced carcinomas and can be combined with radiotherapy and progestin treatment. The prognosis is usually favorable in cancers diagnosed at an early stage.

Definition

References:[1][2]

Etiology

The development of type I endometrial cancers has been shown to be directly related to long-term exposure to increased estrogen levels. Type II endometrial cancer is mostly estrogen-independent and is strongly associated with a genetic predisposition.

Risk factors for estrogen-dependent tumors

Protective factors

Low estrogen and high progestin or progesterone levels have a protective effect.

References:[1][3][4][5][6]

Epidemiology

  • The most common cancer of the female genital tract in the US
  • Fourth most common cancer in women (after breast, lung, and colorectal cancer)
  • Age: primarily postmenopausal women affected; peak incidence at 65–74 years
    • Onset of type I cancer is usually nearer to menopause; type II cancer typically occurs in women who are much older, with the mean age of diagnosis being 67 years.

References:[1][7][5][8][9]

Epidemiological data refers to the US, unless otherwise specified.

Clinical features

Tumor-related

The majority of endometrial cancers are diagnosed at an early stage and have a good prognosis!

Metastases

References:[1][5][10][11]

Diagnostics

There is no routine screening test for endometrial cancer.

References:[12][7]

Treatment

References:[13][14][15]

Complications

  • Pyometra
    • Purulent infection of the endometrium
    • Caused by obstruction of the cervical opening by the tumor and secondary blood stasis (hematometra)
    • Treated with drainage and dilation of the cervical lumen

We list the most important complications. The selection is not exhaustive.

Prognosis

Cancer stage at diagnosis determines the 5-year survival rate:

References:[9]