II. Epidemiology

  1. Onset age over 50 years in 90% of cases (mean age is 63 years)
    1. Premenopausal diagnosis of Endometrial Cancer occurs in 20% of cases
  2. Most common gynecologic tract cancer
    1. Incidence 1.5 times more common than Ovarian Cancer
    2. Incidence 3 times more common than Cervical Cancer
  3. U.S. Statistics from 2015 (increasing Incidence, doubling in the last 20 years)
    1. Incidence: 54, 870 new cases per year
    2. Mortality: 10,170 deaths per year
    3. ACS Cancer facts and figures
      1. http://www.cancer.org/research/cancerfactsstatistics/index

III. Risk Factors

  1. See Endometrial Cancer Risk Factors (also includes protective factors)
  2. Hereditary Nonpolyposis Colorectal Cancer (HNPCC, Lynch Syndrome) are at high risk of Endometrial Cancer
    1. Offer annual Endometrial Biopsy starting at age 35 years
  3. Paradoxically, Tobacco use is associated with a lower Incidence of Uterine Cancer

IV. Types

  1. Type I - Endometrioid (70 to 75% of cases)
    1. Typically associated with Unopposed Estrogen with Endometrial Hyperplasia as a precursor
  2. Type II - Non-Endometrioid (10%)
    1. Not associated with Unopposed Estrogen, Endometrial Hyperplasia or other typical Endometrial Cancer Risks
    2. Includes serous, papillary, clear cell, mucinous, squamous, an adenosquamous types
    3. Onset at older age, more advanced stage and with worse prognosis (accounts for 40% of mortality)
    4. Most common in black women over age 50 years old
  3. Familial Tumors (10%)
    1. Most associated with Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer, HNPCC)
    2. HNPCC confers a 22-50% lifetime risk of Endometrial Cancer

V. Pathophysiology

  1. See Endometrial Hyperplasia (precursor of Type I, endometrioid cancers)

VI. Symptoms: Presentation (90% of cases)

  1. Abnormal Uterine Bleeding (most common symptom)
  2. Abnormal Vaginal Discharge

VII. Exam

  1. Evaluate for other sources of bleeding (e.g. vagina, Cervix)
  2. Bimanual exam

VIII. Evaluation

  1. See Endometrial Cancer Screening
    1. Covers Indications (includes Endometrial Hyperplasia)
    2. Includes evaluation with Trasvaginal Ultrasound and Endometrial Biopsy
  2. See Dysfunctional Uterine Bleeding

IX. Imaging

  1. See Endometrial Cancer Screening for Transvaginal Ultrasound recommendations
  2. At time of Endometrial Cancer diagnosis
    1. Chest XRay
    2. Trasvaginal Ultrasound (if not already performed)
    3. Consider Pelvic MRI

X. Labs

  1. Urine Pregnancy Test
  2. Pap Smear (if due)
    1. AGUS on Pap Smear may suggest Endometrial Hyperplasia or Endometrial Cancer

XI. Staging

XII. Management

  1. Precautions
    1. Biopsy may under-grade Endometrial Cancer (e.g. Grade I is really a Grade 3)
  2. Surgery
    1. Total Hysterectomy with bilateral salpingoophorectomy
      1. First-line management in Stages I-III
      2. Tumor debulking in Stage IV Endometrial Cancer
      3. Vaginal Hysterectomy is not recommended
        1. Does not allow for abdominal evaluation or lymphadenectomy
    2. Peritoneal washings (pelvic washings)
      1. Indicated in Stages I-III
    3. Para-aortic or pelvic lymph node dissection may be needed depending on staging
      1. Indicated in Stages I-III
  3. Radiation Therapy
    1. Indicated in Stages II, III
  4. Systemic therapy (indicated in Stages III, IV)
    1. Progestins
    2. Tamoxifen
    3. Chemotherapy
      1. Doxorubicin (Adriamycin)
      2. Paclitaxel (Taxol)
  5. Post-treatment surveillance
    1. History and exam every 3-6 months for 2 years, then every 6 months for 3 years, then yearly

XIII. Prognosis

XIV. Prevention

  1. Manage Unopposed Estrogen states (e.g. OCP, weight loss)
  2. Consider prophylactic Hysterectomy at age 40 years old for women with Lynch Syndrome

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Ontology: Endometrial Carcinoma (C0476089)

Definition (NCI) A malignant tumor arising from the epithelium that lines the cavity of the uterine body. The vast majority of endometrial carcinomas are adenocarcinomas; squamous cell and adenosquamous carcinomas represent a minority of the cases. Endometrioid adenocarcinoma is the most frequently seen variant of endometrial adenocarcinoma. Uterine bleeding is an initial clinical sign. The prognosis depends on the stage of the tumor, the depth of myometrial wall invasion, and the degree of differentiation.
Definition (NCI_CDISC) A malignant epithelial neoplasm arising from the lining of the uterine body cavity.
Definition (NCI_NCI-GLOSS) Cancer that forms in the tissue lining the uterus (the small, hollow, pear-shaped organ in a woman's pelvis in which a fetus develops). Most endometrial cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).
Concepts Neoplastic Process (T191)
MSH D016889
SnomedCT 269600001, 154526001, 254878006, 93781006
LNC LA15683-8
English Cancer, Endometrial, Cancers, Endometrial, Endometrial Cancer, Endometrial Cancers, ENDOMETRIAL CANCER, Ca endometrium, Endometrial cancer NOS, Cancer of endometrium, Carcinoma endometrial, Endometrial carcinoma (NOS), Cancer of Endometrium, Cancer of the Endometrium, Cancers, Endometrium, Endometrium Cancer, Endometrium Cancers, endometrium ca, endometrium carcinoma, uterine endometrial cancer, cancer of endometrium, endometrial cancers, endometrium cancer, endometrial ca, Cancer, Endometrium, uterine neoplasm, malignant - of endometrium carcinoma, Endometrial carcinoma (diagnosis), Carcinoma of Endometrium, Carcinoma, Endometrial, Carcinomas, Endometrial, Endometrial Carcinomas, Endometrium Carcinoma, Endometrial Carcinoma, Endometrium Carcinomas, Endometrium--Cancer, CARCINOMA OF THE ENDOMETRIUM, CARCINOMA, ENDOMETRIAL, MALIGNANT, CARCINOMA OF ENDOMETRIUM, Endometrial cancer, Endometrial carcinoma, Endometrial Ca, Endometrial carcinoma (disorder), cancer of the endometrium, carcinoma of the endometrium, endometrial cancer, endometrial carcinoma, Carcinoma of the Endometrium, Carcinoma;endometrial
Dutch endometriumkanker NAO, endometriumcarcinoom, ca endometrium, kanker van het endometrium, endometriumcarcinoom (NAO), carcinoom endometrium, endometriumkanker, Endometriumkanker, Tumor van het endometrium, Endometriumcarcinoom
French Cancer de l'endomètre SAI, Carc de l'endomètre, Carcinome de l'endomètre SAI, Carcinome de l'endomètre, Carcinome endométrial, Cancer endométrial, Cancer de l'endomètre
German Krebs der Endometriums, endometriales Karzinom (NNB), Karzinom des Endometriums, Ka des Endometriums, endometriales Karzinom, Endometriumkarzinom NNB, Endometriumkarzinom, Endometriumkrebs, Karzinom des Endometrium, Krebs des Endometrium
Italian Cancro dell'endometrio, NAS, Cancro dell' endometrio, Carcinoma dell' endometrio, Carcinoma dell'endometrio (NAS), Cancro dell'endometrio, Carcinoma dell'endometrio
Portuguese Carcinoma do endométrio, Ca do endométrio, Cancro do endométrio NE, Cancro do endométrio, Carcinoma do endométrio NE, Carcinoma Endometrial, Cancro endometrial, Câncer do Endométrio, Câncer Endometrial
Spanish Carcinoma endometrial (NEOM), Cáncer de endometrio, Carcinoma endometrial, Ca de endometrio, Cáncer endometrial NEOM, cáncer endometrial, neoplasia maligna del endometrio (trastorno), Carcinoma Endometrial, neoplasia maligna del endometrio, carcinoma endometrial (trastorno), carcinoma endometrial, Cáncer endometrial, Cáncer de Endometrio, Cáncer Endometrial
Japanese 子宮内膜癌NOS, 子宮内膜癌(NOS), 子宮内膜癌, シキュウナイマクガン, シキュウナイマクガンNOS
Czech Ca endometria, Karcinom endometriální, Endometriální karcinom, Maligní nádorové onemocnění endometria, Maligní nádor endometria NOS, Maligní nádor endometria, Endometriální karcinom (NOS), endometriální karcinom, rakovina endometria, karcinom endometria
Hungarian Méhnyálkahártyarák, Endometrialis carcinoma (k.m.n.), Endometrialis carcinoma, Endometrialis rák, Endometrium carcinoma, Endometrialis rák k.m.n.
Norwegian Endometriekarsinomer, Endometriekreft

Ontology: Uterine carcinoma (C0848454)

Concepts Neoplastic Process (T191)
English UTERINE CARCINOMA, Uterine carcinoma, carcinoma of uterus (diagnosis), carcinoma of uterus, uterine carcinoma, Carcinoma;uterus, carcinoma uterus, carcinoma uterine, uterus carcinoma, carcinoma of the uterus
Dutch uteruscarcinoom
French Carcinome utérin, CANCER DE L'UTERUS
German Gebaermutterkarzinom, UTERUSKARZINOM
Italian Carcinoma dell'utero
Portuguese Carcinoma do útero, CARCINOMA UTERINO
Spanish Carcinoma uterino, CARCINOMA UTERINO
Japanese 子宮癌, シキュウガン
Czech Karcinom dělohy
Hungarian Méhcarcinoma