Endometrial Cancer

Endometrial cancer arises from the endometrium, the lining of the uterus. It is characterised by the abnormal growth of cells capable of invasion or spread to other parts of the body. This type of cancer is distinct from other uterine cancers such as cervical cancer and uterine sarcoma.

Signs and Symptoms

The most common symptom is vaginal bleeding, particularly postmenopausal bleeding, which occurs in 90% of cases. Other symptoms can include pain with urination, pain during sexual intercourse, and pelvic pain. Advanced stages may present with more significant symptoms such as a palpable mass or lower abdominal pain.

Risk Factors

Risk factors for endometrial cancer include obesity, excessive oestrogen exposure, high blood pressure, diabetes, and a family history of the disease. Genetic disorders like Lynch syndrome significantly increase the risk. Obesity is particularly notable as it increases the risk by 300–400%. Other risk factors include a history of breast cancer, use of tamoxifen, and late menopause.

Pathophysiology

Endometrial cancer develops when there are errors in normal cell growth. Mutations in tumour suppressor genes like PTEN and p53 are commonly found in endometrial cancers. Loss of PTEN function leads to up-regulation of the PI3k/Akt/mTOR pathway, causing excessive cell growth.

Diagnosis

Diagnosis begins with a physical examination, endometrial biopsy, or dilation and curettage (D&C). Transvaginal ultrasound is often used to assess endometrial thickness. If cancer is suspected, medical imaging such as MRI or CT scans may be employed to evaluate the extent of the disease.

Classification

Endometrial cancers can be classified into Type I and Type II based on clinical and endocrine features. Type I cancers are often low-grade, oestrogen-dependent, and have a good prognosis. Type II cancers are typically high-grade, oestrogen-independent, and have a poorer prognosis. Histopathologically, endometrial cancers can be endometrioid, serous, clear cell, or mucinous.

Staging

Endometrial cancer is staged using the FIGO system, with stages ranging from IA (tumour confined to the uterus with less than half myometrial invasion) to IVB (distant metastases). Staging helps guide treatment and predict prognosis.

Treatment

The primary treatment for endometrial cancer is surgery, typically involving a hysterectomy and bilateral salpingo-oophorectomy. In more advanced stages, lymphadenectomy may also be performed. Adjuvant therapies, such as chemotherapy and radiotherapy, are considered for high-risk or high-grade cancers. Chemotherapy regimens often include paclitaxel, doxorubicin, and carboplatin. Radiotherapy can be delivered as vaginal brachytherapy or external beam radiotherapy.

Hormonal therapy may be beneficial in well-differentiated tumours with hormone receptors. Targeted therapies, such as dostarlimab, are also being looked at.

Prognosis

The prognosis for endometrial cancer is generally favourable, with a five-year survival rate of approximately 80% in the US. Prognosis is better for early-stage cancers and worse for advanced stages. Recurrence rates vary, with most recurrences occurring outside the pelvis within two to three years of treatment.

Epidemiology

Endometrial cancer is the sixth most common cancer in women worldwide, with higher incidence rates in developed countries. It is the most frequently diagnosed gynecologic cancer in the United States and primarily affects women during perimenopause or postmenopause. The incidence is rising, possibly due to increasing obesity rates and longer life expectancies.

Research

Ongoing research is looking at various experimental therapies, including immunologic, hormonal, and chemotherapeutic treatments. Genetic analyses are being used to tailor treatments to specific mutations. Additionally, new diagnostic methods and imaging techniques are being investigated to improve early detection and staging of endometrial cancer.

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Self-assessment MCQs (single best answer)

Here is the formatted text in HTML and pseudocode:

What is the most common symptom of endometrial cancer?

Which of the following is NOT a risk factor for endometrial cancer?

Which tumour suppressor gene is commonly mutated in endometrial cancer?

How is endometrial cancer primarily diagnosed?

What type of endometrial cancer is typically low-grade and oestrogen-dependent?

Which imaging technique is often used to assess endometrial thickness?

What is the primary treatment for endometrial cancer?

Which stage of endometrial cancer indicates distant metastases?

What is the five-year survival rate for endometrial cancer in the US?

Endometrial cancer is most frequently diagnosed in which group of women?