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{{Endometrial cancer}}
{{Endometrial cancer}}
{{CMG}}
{{CMG}}{{AE}}{{MD}}{{RAK}}
 
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==Overview==
==Overview==
In the United States, endometrial cancer is the fourth most common type of cancer among women. Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include ''[[TP53]]'', ''[[KRAS]]'', and ''PTEN''. 8–30% of patients with atypical [[endometrial hyperplasia]] may progress to develop endometrial cancer. The pathophysiology of  endometrial cancer depends on the 7 histological subtype: endometrioid, uterine papillary serous, mucinous,  clear cell, [[squamous cell]], mixed and undifferentiated. Common risk factors in the development of endometrial cancer are estrogen exposure, [[tamoxifen]], [[obesity]], [[diabetes]], [[high blood pressure]] and genetic disorders. The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and [[vaginal bleeding]] and/or spotting in postmenopausal women is suggestive of endometrial cancer. Pelvic [[MRI]] and [[endometrial biopsy]] may be diagnostic of endometrial cancer. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The optimal therapy for endometrial cancer depends on the stage at diagnosis.
In the United States, endometrial cancer is the fourth most common type of cancer among women. Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include ''[[TP53]]'', ''[[KRAS]]'', and ''PTEN''. Approximately 8–30% of patients with atypical [[endometrial hyperplasia]] may progress to develop endometrial cancer. The pathophysiology of  endometrial cancer depends on the 7 histological subtypes: endometrioid, uterine papillary serous, mucinous,  clear cell, [[squamous cell]], mixed and undifferentiated. Common risk factors in the development of endometrial cancer are estrogen exposure, [[tamoxifen]], [[obesity]], [[diabetes]], [[high blood pressure]] and genetic disorders. The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and [[vaginal bleeding]] and/or spotting in postmenopausal women is suggestive of endometrial cancer. Pelvic [[MRI]] and [[endometrial biopsy]] may be diagnostic of endometrial cancer. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The optimal therapy for endometrial cancer depends on the stage at diagnosis and comprises total hysterectomy and bilateral salpingo-oophorectomy to most patients if they are surgical candidates.
 
==Historical Perspective==
The earliest descriptions of endometrial cancer were reported in the early 1900s. The association between estrogen and development of endometrial cancer was first reported in the 1970s when the incidence of endometrial cancer significantly increased between 1970 and 1975 following the introduction of estrogen replacement therapy.


==Classification==
==Classification==
Endometrial cancer may be classified according to histology into 7 subtypes: endometrioid, uterine papillary serous, mucinous,  clear cell, squamous cell, mixed, and undifferentiated.
Endometrial cancer may be classified according to histology into either type I comprising 80% of endometrial cancers or type II accounting for around 20%.


==Pathophysiology==
==Pathophysiology==
Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include ''[[TP53]]'', ''[[KRAS]]'', and ''PTEN''. The pathophysiology of endometrial cancer depends on the histological subtype.
Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include ''[[TP53]]'', ''[[KRAS]]'', and ''PTEN''. The pathophysiology of endometrial cancer depends on the histological subtype.
 
==Causes==
Causes of endometrial cancer include genetic mutations of the ''[[KRAS]]'' gene, ''[[TP53]]'' gene, ''[[P16 (gene)|TP16]]'' gene, and/or ''[[PTEN]]'' gene. Other genetic mutations have also been described.


==Differential Diagnosis==
==Differential Diagnosis==
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
In the United States, endometrial cancer is the fourth most common type of cancer among women.<ref name=CDC>[http://www.cdc.gov/cancer/uterine/statistics/index.htm Uterine cancer statistics. CDC.gov]</ref> In the United States, the age-adjusted [[prevalence]] of  endometrial cancer is 231.9 per 100,000 in 2011 and the age-adjusted [[incidence]] of  endometrial cancer was 27.05 per 100,000 persons.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
In the United States, endometrial cancer is the fourth most common type of cancer among women. In 2011, the age-adjusted [[prevalence]] was approximately 232 per 100,000 and the age-adjusted [[incidence]] was approximately 27 per 100,000 in the USA.


==Risk Factors==
==Risk Factors==
Common risk factors in the development of endometrial cancer are [[estrogen]] exposure, [[tamoxifen]] use, [[obesity]], [[diabetes]], [[high blood pressure]] and genetic disorders.
Common risk factors in the development of endometrial cancer are [[estrogen]] exposure, [[tamoxifen]] use, [[obesity]], [[diabetes]], [[high blood pressure]] and genetic disorders.
==Screening==
There is insufficient evidence to recommend routine screening for endometrial cancer.


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
If left untreated, approximately 8–30% of patients with atypical [[endometrial hyperplasia]] may progress to develop endometrial cancer. Common complications of endometrial cancer include [[vaginal bleeding]] and [[metastasis]]. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary.  However, the prognosis is generally regarded as good.
If left untreated, approximately 8–30% of patients with atypical [[endometrial hyperplasia]] may progress to develop endometrial cancer. Common complications of endometrial cancer include [[menorrhagia]] and [[metastasis]]. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary.  However, the prognosis is generally regarded as good.


==Diagnosis==
==Diagnosis==
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The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and [[vaginal bleeding]] and/or spotting in postmenopausal women is suggestive of endometrial cancer.
The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and [[vaginal bleeding]] and/or spotting in postmenopausal women is suggestive of endometrial cancer.


===Chest Xray===
===MRI===
[[Chest radiography]] (CXR) may be helpful in the diagnosis of [[pulmonary]] [[metastasis]] of endometrial cancer. The characteristic findings of [[pulmonary]] [[metastasis]] on chest radiography appears as peripheral, rounded nodules of variable size, scattered throughout both [[lungs]].
The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.
 
===CT===
Pelvic postcontrast CT scan may be helpful in the diagnosis of endometrial cancer.


===MRI===
===Ultrasound===
Pelvic MRI may be diagnostic of endometrial cancer. The MRI findings of endometrial cancer vary according to FIGO staging.<ref>{{Cite web | title =endometrial cancer MRI  | url =http://radiopaedia.org/articles/endometrial-carcinoma}}</ref>
On transvaginal ultrasound, endometrial cancer is characterized by thickening of the [[endometrium]] and disruption of a subendometrial halo.


===Other Diagnostic Studies===
===Other Diagnostic Studies===
[[Endometrial biopsy]] may be diagnostic of endometrial cancer.
Other diagnostic studies for endometrial cancer include endometrial [[biopsy]]


==Treatment==
==Treatment==
===Medical therapy===
===Medical therapy===
The optimal therapy for endometrial cancer depends on the stage at diagnosis. A combination of chemotherapy and radiation therapy is indicated in Stages(IIIB- IV).
The optimal therapy for endometrial cancer depends on the stage at diagnosis. A combination of [[chemotherapy]] and [[radiation therapy]] is indicated in stages IIIB- IV.


===Surgery===
===Surgery===
The feasibility of surgery depends on the stage of endometrial cancer at diagnosis. Surgery is the mainstay of treatment for endometrial cancer stage(I-III).
Surgery is the mainstay of treatment for endometrial cancer stage I-III.


===Primary Prevention===
===Primary Prevention===
Effective measures for the primary prevention of endometrial cancer include a diet low in saturated fats and high in fruits and vegetables, physical activity and combination oral contraceptives.
Effective measures for the primary prevention of endometrial cancer include administration of combination [[oral contraceptives]].
 
===Secondary Prevention===
===Tertiary  Prevention===
The aim of tertiary prevention is to diagnose [[metastasis]] and tumor recurrence.


==References==
==References==
{{reflist|2}}
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Latest revision as of 16:35, 21 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]Roukoz A. Karam, M.D.[3]


Overview

In the United States, endometrial cancer is the fourth most common type of cancer among women. Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. Approximately 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. The pathophysiology of endometrial cancer depends on the 7 histological subtypes: endometrioid, uterine papillary serous, mucinous, clear cell, squamous cell, mixed and undifferentiated. Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen, obesity, diabetes, high blood pressure and genetic disorders. The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer. Pelvic MRI and endometrial biopsy may be diagnostic of endometrial cancer. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The optimal therapy for endometrial cancer depends on the stage at diagnosis and comprises total hysterectomy and bilateral salpingo-oophorectomy to most patients if they are surgical candidates.

Historical Perspective

The earliest descriptions of endometrial cancer were reported in the early 1900s. The association between estrogen and development of endometrial cancer was first reported in the 1970s when the incidence of endometrial cancer significantly increased between 1970 and 1975 following the introduction of estrogen replacement therapy.

Classification

Endometrial cancer may be classified according to histology into either type I comprising 80% of endometrial cancers or type II accounting for around 20%.

Pathophysiology

Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. The pathophysiology of endometrial cancer depends on the histological subtype.

Causes

Causes of endometrial cancer include genetic mutations of the KRAS gene, TP53 gene, TP16 gene, and/or PTEN gene. Other genetic mutations have also been described.

Differential Diagnosis

Endometrial cancer in early stage must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp, and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.

Epidemiology and Demographics

In the United States, endometrial cancer is the fourth most common type of cancer among women. In 2011, the age-adjusted prevalence was approximately 232 per 100,000 and the age-adjusted incidence was approximately 27 per 100,000 in the USA.

Risk Factors

Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen use, obesity, diabetes, high blood pressure and genetic disorders.

Screening

There is insufficient evidence to recommend routine screening for endometrial cancer.

Natural History, Complications and Prognosis

If left untreated, approximately 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. Common complications of endometrial cancer include menorrhagia and metastasis. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.

Diagnosis

Staging

According to the FIGO Staging System, there are 4 stages of endometrial cancer.

History and Symptoms

The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer.

MRI

The MRI is not needed for the diagnosis of endometrial cancer. However, an MRI may be helpful in staging of the disease.

Ultrasound

On transvaginal ultrasound, endometrial cancer is characterized by thickening of the endometrium and disruption of a subendometrial halo.

Other Diagnostic Studies

Other diagnostic studies for endometrial cancer include endometrial biopsy

Treatment

Medical therapy

The optimal therapy for endometrial cancer depends on the stage at diagnosis. A combination of chemotherapy and radiation therapy is indicated in stages IIIB- IV.

Surgery

Surgery is the mainstay of treatment for endometrial cancer stage I-III.

Primary Prevention

Effective measures for the primary prevention of endometrial cancer include administration of combination oral contraceptives.

References


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