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Endometrial Cancer

Endometrial cancer is the most common gynecologic malignancy. 2-3% of women will develop endometrial cancer at some time during their lives.

This malignancy is predominantly a disease of postmenopausal women. When endometrial cancer develops before age 40, it occurs most often in women who are obese or chronically anovulatory.

The principal risk factor for endometrial cancer is chronic, unopposed estrogen exposure, due to early menarche, late menopause, obesity, chronic anovulation, estrogen-secreting ovarian tumors, or treatment with unopposed estrogen.

Other factors that have been associated with endometrial cancer include pelvic radiation and breast or ovarian cancer.

Diagnosis

90% of patients present with abnormal uterine bleeding occurring after menopause. Only 1-5% present with abnormal cells on Pap smear.

Endometrial cancer should be suspected in postmenopausal women who have any bleeding, and in perimenopausal women who have increased menstrual flow, a decreased menstrual interval, or intermenstrual bleeding.

The Pap smear cannot be relied upon to detect endometrial cancer. However, endometrial cancer should be suspected when atypical endometrial cells are found in the Pap smear of a nonpregnant woman of any age, or when normal endometrial cells are found in a postmenopausal woman not taking estrogens.

Evaluation of Suspected Endometrial Cancer

A Pap smear of the ectocervix and endocervix should be completed.

The uterus, adnexa, cervix, vagina, and rectum should be palpated by bimanual rectovaginal exam for masses, nodularity, induration, and immobility.

Endometrial sampling with a Pipelle aspirator is indicated in postmenopausal women with vaginal bleeding or perimenopausal women with a menstrual abnormality.

Suspicious lesions are biopsied.

A stool occult blood test is completed.

Endocervical curettage is necessary because endocervical carcinoma can missed by endometrial biopsy.

If the endometrial biopsy has been performed and no significant abnormality was detected, no further evaluation is needed. If high-risk factors are present and the cause of the bleeding remains undiagnosed, a fractional D&C should be completed. Hysteroscopy may also be helpful to evaluate the endometrium further.

If endometrial cancer is diagnosed, the supraclavicular

Treatment