creation date: 2026-11-01 13:55
tags: Pathologies
Endometrial Cancer
Background
Definitions
Endometrial cancers are cancers of the endometrium within the uterus.
Etiology & Risk Factors
ECs that originate from atypical endometrial hyperplasia or endometriod intraepithelial neoplasia are associated with:
- POLE mutations
- Loss of MMR expression
Serous endometrial intraepithelial carcinoma arise from atypical grandular epithelial cells lining the endometrial glands.
Subtypes
Endometrioid carcinoma
- 75-80% of cases
- Composed of tall columnar cells
- FIGO grade 1-3 based on amount of solid growth
Serous endometrial carcinoma
- 10% of cases
- Neoplastic cells form papillary structures and glands with serrated outlines
Clear cell carcinoma
- Similar morphologic features with ovarian clear cell carcinoma
Mixed carcinoma
- At least two distinct histologic components
- Typically clonal rather than two synchronous, independent primary neoplasms
Undifferentiated/dedifferentiated carcinoma
- No glandular or squamous differentiation
Carcinosarcoma
- Previously known as malignant mixed Mullerian tumour
- High-grade sarcoma component with a high-grade carcinoma
Clinical Presentation
Signs & Symptoms
The primary presentation of endometrial cancer is:
- Abnormal uterine bleeding/menorrhagia
- Postmenopausal bleeding
History & Physical Exam
In addition to history regarding presenting symptoms, history should include:
- Family history of cancers
- Menopause status
- Prior abdominal surgeries (in cases where operation is needed)
Diagnosis
Criteria
Diagnosis is made via histopathology. This is typically done via Pipelle biopsy, D&C with/without hysteroscopy, or hysterectomy specimen.
Work-up
Following initial histopathology, further workup may be warranted based on findings.
- For MMR deficient, further reflex pathology is ordered for Lynch syndrome
- Genetic testing if multiple cancers/risk factors
Staging
CT imaging is performed to stage for metastases. Sentinel lymph node biopsy completed during hysterectomy is also used for staging.
Differential
Red Flags / Complications
Management
Treatment typically consist of total laparoscopic hysterectomy, bilateral salpingo-oophrectomy. Post-surgical pathology will determine if further treatment is needed which may include:
- Radiation therapy
- Chemotherapy (adjunct to radiation)
In many cases, surgery and monitoring after is sufficient.