- Clinical science
Endometrial cancer is the most common cancer of the female genital tract in the US, with a peak incidence between 65 and 74 years of age. Endometrial cancers can be divided into two types based on histological characteristics; type I cancers account for 80% of all endometrial cancers and are of endometrioid origin, while type II cancers originate mostly 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, and abdominal x-ray) are usually required for the detection and staging of metastases. Treatment of early-stage endometrial cancer involves total hysterectomy with bilateral salpingo-oophorectomy 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.
- Type I endometrial cancer: endometrioid adenocarcinomas (grade 1 and 2) derived from atypical endometrial hyperplasia 
- Type II endometrial cancer: endometrioid adenocarcinomas (grade 3) and tumors of nonendometrioid histology; (serous, clear cell, mucinous, squamous, transitional, and undifferentiated cells) 
Type I endometrial cancer
- Directly related to long-term exposure to increased estrogen levels
- Some genetic mutations (e.g., in the PTEN gene or mismatch repair genes) are also associated with this type of cancer.
Type II endometrial cancer
- Mostly estrogen-independent
- Associated with endometrial atrophy (especially in postmenopausal women)
- Strongly associated with a genetic predisposition
Risk factors for estrogen-dependent tumors
- Early menarche and late menopause
- (esp. obesity and diabetes mellitus type 2 )
- Unopposed estrogen replacement therapy (e.g., for menopausal symptoms)
- History of breast cancer and tamoxifen treatment
- (hereditary nonpolyposis colorectal cancer)
- Prevalence 
- Incidence: ∼ 20–28 per 100,000 women per year 
- Age 
Epidemiological data refers to the US, unless otherwise specified.
- Abnormal uterine bleeding is the main symptom.
- Later stages may present with pelvic pain, palpable abdominal mass, and/or weight loss.
- Pelvic exam is often normal. Possible findings include:
The majority of endometrial cancers are diagnosed at an early stage and have a good prognosis.
- Localized metastasis: contiguous spread to the cervix and vagina, fallopian tubes, and ovaries (25% of cases)
- Lymphogenic metastasis
- Occurs at a very late stage and usually in the lungs
Endometrial biopsy with histology 
- Considered to be the first diagnostic step by some experts since it is noninvasive and enables initial assessment
- Regular monitoring required in postmenopausal women with endometrial thickening ≥ 5 mm
- Abdominal ultrasonography: A complete abdominal ultrasound is indicated to exclude metastasis.
- Chest x-ray, CT, MRI: assessment of metastatic spread (lungs, pelvis)
Endometrioid adenocarcinoma 
- Prevalence: most frequent form
Tumors of nonendometrioid histology
Surgical management 
- Indication: women with endometrial cancer who are postmenopausal, perimenopausal, or do not intend to become pregnant
- An accumulation of pus in the uterine cavity
- Caused by infection resulting from obstruction of the cervical opening by the tumor and secondary blood stasis (hematometra)
- Can develop in patients with duplication of the cervix or as an uncommon complication of gynecological malignancy
- Presented with purulent vaginal discharge, lower abdominal pain, and enlarged uterus
- Diagnosed by imaging studies (e.g., abdominal ultrasound or CT scan)
- Treated with drainage and dilation of the cervical lumen
We list the most important complications. The selection is not exhaustive.
- Endometrial cancer has the 2nd best prognosis (after cervical cancer) of all gynecological cancers in the US. 
- Cancer stage at diagnosis determines the 5-year survival rate: 
- Death rate: 4.9 per 100,000 women per year 
- Types of endometrial carcinomas that are well-differentiated and possess estrogen receptors (type I) have a more favorable prognosis.
- Clear cell and papillary serous carcinomas (type II) have an aggressive course and a poor prognosis.
To remember the prognoses of gynecological cancers, think of “CEOs (Cervical, Endometrial, Ovarian cancers) progressively decline.