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An in depth medical article on Endometrial Cancer covering epidemiology causes risk factors pathogenesis clinical presentation diagnosis staging treatment strategies prevention and prognosis written in a professional format suitable for international publication.
Epidemiology and Overview
Endometrial cancer is the most common malignancy of the female reproductive system and the fourth most common cancer among women worldwide. It primarily affects postmenopausal women with the majority of cases diagnosed between the ages of fifty and seventy. The incidence is higher in developed countries due to lifestyle factors such as obesity and longer life expectancy. Early stage disease is often curable but advanced stage cancer carries a more guarded prognosis.
Pathophysiology and Etiology
Endometrial cancer arises from the inner lining of the uterus known as the endometrium. It is broadly classified into two types. Type I endometrial cancer is estrogen dependent and accounts for the majority of cases. It usually develops from a background of endometrial hyperplasia and has a relatively favorable prognosis. Type II is non estrogen dependent, tends to occur in older women, is more aggressive and includes histological subtypes such as serous carcinoma and clear cell carcinoma.
Prolonged exposure to unopposed estrogen is the most significant etiological factor. Estrogen stimulates endometrial proliferation while progesterone counterbalances this effect. A deficiency of progesterone either due to hormonal therapy, anovulation or menopause leads to continuous endometrial stimulation and increases the risk of malignant transformation.
Risk Factors
Several risk factors contribute to the development of endometrial cancer. These include advancing age particularly postmenopausal women, obesity which increases peripheral conversion of androgens to estrogen, early menarche, late menopause, nulliparity, polycystic ovary syndrome, estrogen replacement therapy without progesterone, tamoxifen use, diabetes, hypertension, and genetic syndromes such as Lynch syndrome. Family history of endometrial or colorectal cancer also increases risk.
Clinical Presentation
Abnormal uterine bleeding is the hallmark symptom and the most common presenting feature. In postmenopausal women any vaginal bleeding should be considered abnormal and warrants immediate investigation. Other symptoms may include watery or blood tinged vaginal discharge, pelvic pain, discomfort during intercourse, a feeling of pelvic fullness, and unintentional weight loss. Advanced disease may present with urinary or bowel symptoms if adjacent structures are involved.
Diagnostic Evaluation
Diagnosis requires a systematic approach to confirm malignancy and assess its extent.
A pelvic examination is performed to assess uterine size and detect abnormalities. Transvaginal ultrasound evaluates the thickness and structure of the endometrium. An endometrial biopsy remains the gold standard for diagnosis providing histopathological confirmation. Hysteroscopy allows direct visualization and targeted sampling of suspicious areas. If biopsy results are inconclusive dilation and curettage may be performed.
Staging investigations include imaging such as MRI and CT scans to determine local invasion and distant spread. Chest imaging may be done to check for pulmonary metastases. Laboratory tests help assess general health and fitness for surgery.
Staging and Classification
Endometrial cancer is staged surgically according to the FIGO classification system.
Stage I is confined to the uterine corpus.
Stage II involves the cervical stroma but does not extend beyond the uterus.
Stage III shows local and regional spread to the adnexa, vagina, or pelvic lymph nodes.
Stage IV indicates invasion of the bladder or bowel mucosa or distant metastasis to organs such as the lungs or liver.
Grading is based on histological differentiation ranging from well differentiated to poorly differentiated tumors which correlates with aggressiveness and prognosis.
Treatment Strategies
Management depends on the stage, histological type, grade, and patient factors such as age, fertility desires, and comorbidities.
Surgical management is the mainstay of treatment and usually involves total hysterectomy with bilateral salpingo oophorectomy and lymph node assessment. Minimally invasive approaches are preferred when feasible.
Adjuvant radiotherapy may be used to reduce the risk of local recurrence especially in intermediate or high risk disease. Chemotherapy is employed for advanced or recurrent cancer commonly using platinum based regimens.
Hormonal therapy with progestins or selective estrogen receptor modulators may be considered in hormone receptor positive tumors or in patients who are not surgical candidates. Targeted therapies and immunotherapy are emerging options for specific molecular subtypes particularly those with mismatch repair deficiency.
Prevention and Risk Reduction
Preventive measures focus on modifiable risk factors. Maintaining a healthy weight through balanced nutrition and regular physical activity reduces estrogen related risk. Combined oral contraceptives used under medical supervision have a protective effect by providing progesterone. Managing chronic conditions such as diabetes and polycystic ovary syndrome is important. Women with genetic syndromes may benefit from surveillance or prophylactic surgery. Prompt evaluation of abnormal uterine bleeding allows early detection and intervention.
Prognosis and Survival
The prognosis for endometrial cancer is generally favorable when diagnosed early. Stage I disease has a five year survival rate exceeding ninety percent. Prognosis worsens with higher stage, aggressive histological subtypes, lymphovascular invasion, and delayed treatment. Regular follow up is essential for early detection of recurrence which typically occurs within the first three years after treatment. Long term outcomes continue to improve with advances in surgical techniques, adjuvant therapy, and personalized treatment approaches.
Frequently Asked Questions
What is the earliest sign of endometrial cancer
The earliest and most common sign is abnormal vaginal bleeding particularly after menopause.
Can endometrial cancer be prevented
While not all cases can be prevented risk can be significantly reduced through weight management hormonal balance prompt evaluation of abnormal bleeding and genetic counseling when indicated.
Is endometrial cancer curable
Yes when diagnosed at an early stage it is often curable with surgery and has an excellent prognosis.
Who is most at risk
Postmenopausal women individuals with obesity hormonal imbalances Lynch syndrome or a history of irregular ovulation are at higher risk.
Is there a screening test for endometrial cancer
There is no routine screening for average risk women. However women with genetic syndromes or strong family history may undergo regular surveillance.
Conclusion
Endometrial cancer remains a major health issue but early detection and advances in treatment have significantly improved survival outcomes. Understanding its epidemiology pathogenesis risk factors clinical presentation and management is essential for effective prevention and timely intervention. Comprehensive awareness among both patients and healthcare providers ensures early diagnosis and better prognosis.
Dr. Tahmina Akhtar
MBBSDGO (DU)
Infertility Specialist Gynecologist & Obstetrician
18 Years of Experience Overall
BMDC Reg.: Coming Soon
ID: D75HY58
