Overview

• Malignancy arising from endometrial tissue. 2nd most common gynae malignancy in UK.
• Classically seen in post-menopausal women but around 25% of cases occur before the menopause.
• Most commonly adenocarcinoma.
• Risk Factors:
  • Excess Oestrogen → nulliparity, early menarche, late menopause, unopposed oestrogen (HRT).
  • Metabolic Syndrome → obesity, diabetes mellitus, polycystic ovarian syndrome.
  • Tamoxifen (acts as oestogen receptor agonist at the endometrium - but an antagonist in breast tissue).
  • Hereditary non-polyposis colorectal carcinoma (HNPCC).
  • Granulosa Cell Tumour (sex-cord stromal ovarian tumours) → produce oestrogen.
• Protective Factors → multiparity, COCP, smoking.

Making Diagnosis

Clinical Features

• Postmenopausal Bleeding → usually slight and intermittent initially before becoming heavier.
• Unexplained symptoms of vaginal discharge.

Investigations

• All women ≥55 years with postmenopausal bleeding should be referred using the suspected cancer pathway.
• 1st Line → trans-vaginal ultrasound (TVUSS). Thickened endometrium indicates endometrial cancer.
  • If endometrial thickness <4mm then unlikely to be endometrial cancer.
• If >4mm on TVUSS → Hysteroscopy with biopsy.
  • Can also do pipelle biopsy.

<aside> 💡 One-Stop Clinic (PMB): TVUSS → Pipelle Biopsy with or without outpatient hysteroscopy and histopathology. If outpatient (pipelle) biopsy not feasible or cannot be tolerated, do hysteroscopy under anaesthesia.

</aside>

• CT CAP for FIGO staging.
  • I = uterus
  • II = uterus + cervix
  • III = adnexa
  • IV = distant metastasis / bladder / bowel