Endometrial Cancer

Question 1

What is it?

Answer 1

A malignancy that originates from the endometrium, the inner lining of the uterus.

Question 2

What is the main risk factor and how can it be caused?

Answer 2

Unopposed oestrogen

Nulliparity
Obesity
Early menarche
Late menopause
Polycystic ovary syndrome
Oestrogen-only hormone replacement therapy

Question 3

What are the clinical manifestations?

Answer 3

Mainly: Postmenopausal bleeding

Abnormal vaginal bleeding, such as intermenstrual bleeding
Dyspareunia
Pelvic pain
Abdominal discomfort or bloating
Weight loss
Anaemia

Bimanual pelvic examination can reveal an enlarged uterus

Question 4

What conditions are the main differentials?

Answer 4

Uterine fibroids: Characterised by heavy menstrual bleeding, pelvic pressure or pain, frequent urination, and constipation.

Endometrial polyps: Symptoms may include irregular menstrual bleeding, bleeding between menstrual periods, excessively heavy menstrual periods, and vaginal bleeding after menopause.

Cervical cancer: Signs can include abnormal vaginal bleeding, postmenopausal bleeding, and pelvic pain.

Question 5

What are investigations?

Answer 5

Transvaginal ultrasound: Employed to detect any abnormal thickening of the endometrium.

Endometrial biopsy: Tissue is obtained either via hysteroscopy or pipelle for histopathological examination.

Question 6

How can it be managed?

Answer 6

For cancer limited to the uterus, a hysterectomy with bilateral salpingo-oophorectomy can be curative.

In cases where the cancer has spread outside of the uterus, treatment often involves a combination of surgery, radiotherapy, and chemotherapy.