Obstetrics and Gynaecology · MU Sofia

53. Endometrial cancer

Covers endometrial cancer, from its epidemiology and the two histological types with their causes, patients and prognoses, to the molecular classification. It then lists risk factors, including protective ones, the diagnostic workup, and the precursor endometrial hyperplasia. The note ends with the FIGO staging and the surgical, adjuvant and fertility-sparing treatment options. A comparison table sets out Type I against Type II, and a second table gives the simplified FIGO stages.

Inside: 6 sections · 2 tables · 15 flashcards · 2 min

Topic 53 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 6 sections, about 229 words (2 min of reading), with 15 flashcards.

In this note

  1. Introduction
  2. Types
  3. Risk factors
  4. Diagnosis
  5. Staging (FIGO, simplified)
  6. Treatment

Introduction

Endometrial cancer is the most common gynaecological cancer in developed countries. It usually presents early, with postmenopausal bleeding, so most cases are cured. Peak age is 60–70.

Types

Since FIGO 2023 the molecular classification is also used: POLE-mutated (excellent prognosis), mismatch repair deficient (MMRd, Lynch syndrome), no specific molecular profile, and p53-abnormal (worst prognosis). These change the stage in early disease.

Risk factors

  • Obesity (peripheral conversion of androgens to oestrogen), nulliparity, early menarche, late menopause.
  • Unopposed oestrogen HRT, PCOS (anovulation), oestrogen-secreting tumours (granulosa cell).
  • Tamoxifen, diabetes, hypertension, Lynch syndrome (lifetime risk up to 40–60%).
  • Protective: combined pill, progestogen IUS, pregnancy, smoking (but no one recommends it).

Diagnosis

  1. Transvaginal ultrasound: postmenopausal endometrium > 4 mm needs sampling.
  2. Endometrial biopsy (Pipelle) or hysteroscopy with biopsy (or fractional curettage).
  3. Staging: MRI pelvis (myometrial and cervical invasion), CT chest and abdomen; surgical staging.

Precursor: endometrial hyperplasia

  • Without atypia: progestogens (levonorgestrel IUS), low risk of cancer.
  • Atypical hyperplasia (endometrial intraepithelial neoplasia): high risk of coexisting cancer; total hysterectomy (or progestogens if fertility is wanted).

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