Endometrial Cancer from Detection to Treatment
What Is Endometrial Cancer?
Endometrial cancer starts in the lining of the uterus | endometrium.
It is the most common type of uterine cancer.
Most cases occur in postmenopausal women, but it can affect younger women as well.
Endometrial cancer starts in the lining of the uterus | endometrium.
It is the most common type of uterine cancer.
Most cases occur in postmenopausal women, but it can affect younger women as well.
1. Initial Evaluation
Medical History and Physical Exam
Common symptoms:
• Abnormal vaginal bleeding
• Heavy or irregular menstrual periods
• Watery or blood-tinged discharge
• Pelvic pain or pressure
• Pain during urination or intercourse
Risk factors include:
• Postmenopausal status
• Obesity or diabetes
• Unopposed estrogen therapy
• Polycystic ovarian syndrome
• Genetic syndromes like Lynch syndrome
• Family history of endometrial | ovarian | or colorectal cancer
Medical History and Physical Exam
Common symptoms:
• Abnormal vaginal bleeding
• Heavy or irregular menstrual periods
• Watery or blood-tinged discharge
• Pelvic pain or pressure
• Pain during urination or intercourse
Risk factors include:
• Postmenopausal status
• Obesity or diabetes
• Unopposed estrogen therapy
• Polycystic ovarian syndrome
• Genetic syndromes like Lynch syndrome
• Family history of endometrial | ovarian | or colorectal cancer
2. Physical and Pelvic Examination
• Speculum and bimanual exam to inspect cervix and uterus.
• Look for enlarged uterus | abnormal discharge | or cervical lesions.
• If abnormal bleeding is present ➧ proceed to imaging and biopsy.
• Speculum and bimanual exam to inspect cervix and uterus.
• Look for enlarged uterus | abnormal discharge | or cervical lesions.
• If abnormal bleeding is present ➧ proceed to imaging and biopsy.
3. Imaging and Scanning Tests
Transvaginal Ultrasound
First-line imaging test.
Measures endometrial thickness.
Detects masses | fluid | or polyps.
Pelvic | Abdominal CT Scan
Assesses tumor spread to lymph nodes, pelvis, or abdomen.
MRI
Provides detailed visualization of depth of invasion into the uterus and surrounding tissues.
Crucial for staging and surgical planning.
Chest X-ray | CT Chest
Assesses tumor spread to lymph nodes, pelvis, or abdomen.
Transvaginal Ultrasound
First-line imaging test.
Measures endometrial thickness.
Detects masses | fluid | or polyps.
Pelvic | Abdominal CT Scan
Assesses tumor spread to lymph nodes, pelvis, or abdomen.
MRI
Provides detailed visualization of depth of invasion into the uterus and surrounding tissues.
Crucial for staging and surgical planning.
Chest X-ray | CT Chest
Assesses tumor spread to lymph nodes, pelvis, or abdomen.
4. Diagnostic Procedures
Endometrial Biopsy
Performed in the office using a thin suction device | Pipelle.
Quick and minimally invasive.
Confirms the presence and type of cancer cells.
Dilation and Curettage
Done under anesthesia if biopsy is inconclusive or insufficient.
Tissue scraped from uterine lining and sent for pathology.
Hysteroscopy
A camera is inserted into the uterus to visualize and biopsy suspicious areas.
Endometrial Biopsy
Performed in the office using a thin suction device | Pipelle.
Quick and minimally invasive.
Confirms the presence and type of cancer cells.
Dilation and Curettage
Done under anesthesia if biopsy is inconclusive or insufficient.
Tissue scraped from uterine lining and sent for pathology.
Hysteroscopy
A camera is inserted into the uterus to visualize and biopsy suspicious areas.
5. Pathology and Histologic Types
Most common type:
Endometrioid adenocarcinoma
Other types:
Serous carcinoma
Clear cell carcinoma
Carcinosarcoma | aggressive
Tumors are also graded | 1 to 3 | based on how abnormal the cells look under a microscope.
Most common type:
Endometrioid adenocarcinoma
Other types:
Serous carcinoma
Clear cell carcinoma
Carcinosarcoma | aggressive
Tumors are also graded | 1 to 3 | based on how abnormal the cells look under a microscope.
6. Staging | FIGO System
I - Confined to uterus.
II - Spread to cervix but not beyond uterus.
III - Spread to pelvic tissues | ovaries | or lymph nodes.
IV - Spread to bladder | bowel | or distant organs.
I - Confined to uterus.
II - Spread to cervix but not beyond uterus.
III - Spread to pelvic tissues | ovaries | or lymph nodes.
IV - Spread to bladder | bowel | or distant organs.
7. Multidisciplinary Treatment Planning
Team includes:
• Gynecologic Oncologist
• Radiation Oncologist
• Medical Oncologist
• Pathologist
• Radiologist
• Genetic Counselor
Team includes:
• Gynecologic Oncologist
• Radiation Oncologist
• Medical Oncologist
• Pathologist
• Radiologist
• Genetic Counselor
8. Treatment Options
➛ Surgery
Standard procedure
Total Hysterectomy:
Removal of uterus and cervix.
Bilateral Salpingo-Oophorectomy:
Removal of both ovaries and fallopian tubes.
Pelvic and Para-aortic Lymph Node Dissection:
Checks for spread.
Omentectomy:
Removal of fatty tissue near abdomen.
Minimally invasive options:
Laparoscopic
Robotic-assisted hysterectomy.
➛ Fertility-sparing option:
High-dose progestin therapy with close monitoring instead of surgery.
➛ Radiation Therapy
Used:
After surgery to prevent recurrence | adjuvant therapy.
As primary treatment if surgery is not possible.
Types:
External Beam Radiation Therapy
Brachytherapy | Internal Radiation
➛ Chemotherapy
Used for:
Advanced or recurrent disease.
High-grade tumors | serous or clear cell.
Common drugs:
Carboplatin + Paclitaxel | standard combination.
Doxorubicin, Cisplatin if recurrence occurs.
➛ Hormone Therapy
For hormone receptor-positive cancers or recurrence:
Progestins | Megestrol acetate, Medroxyprogesterone.
Tamoxifen or Aromatase inhibitors in select cases.
➛ Targeted and Immunotherapy
Pembrolizumab | Keytruda:
For advanced or recurrent cancer with MSI-H or PD-L1 positivity.
Lenvatinib + Pembrolizumab:
sed in advanced resistant cases.
Trastuzumab:
For HER2-positive serous carcinoma.
➛ Surgery
Standard procedure
Total Hysterectomy:
Removal of uterus and cervix.
Bilateral Salpingo-Oophorectomy:
Removal of both ovaries and fallopian tubes.
Pelvic and Para-aortic Lymph Node Dissection:
Checks for spread.
Omentectomy:
Removal of fatty tissue near abdomen.
Minimally invasive options:
Laparoscopic
Robotic-assisted hysterectomy.
➛ Fertility-sparing option:
High-dose progestin therapy with close monitoring instead of surgery.
➛ Radiation Therapy
Used:
After surgery to prevent recurrence | adjuvant therapy.
As primary treatment if surgery is not possible.
Types:
External Beam Radiation Therapy
Brachytherapy | Internal Radiation
➛ Chemotherapy
Used for:
Advanced or recurrent disease.
High-grade tumors | serous or clear cell.
Common drugs:
Carboplatin + Paclitaxel | standard combination.
Doxorubicin, Cisplatin if recurrence occurs.
➛ Hormone Therapy
For hormone receptor-positive cancers or recurrence:
Progestins | Megestrol acetate, Medroxyprogesterone.
Tamoxifen or Aromatase inhibitors in select cases.
➛ Targeted and Immunotherapy
Pembrolizumab | Keytruda:
For advanced or recurrent cancer with MSI-H or PD-L1 positivity.
Lenvatinib + Pembrolizumab:
sed in advanced resistant cases.
Trastuzumab:
For HER2-positive serous carcinoma.
9. Supportive & Rehabilitative Care
➛ Pain and nausea management during chemo or radiation.
➛ Nutritional counseling to maintain healthy weight.
➛ Hormonal management after ovary removal.
➛ Psychological and emotional support groups.
➛ Physical therapy for mobility and pelvic health recovery.
➛ Pain and nausea management during chemo or radiation.
➛ Nutritional counseling to maintain healthy weight.
➛ Hormonal management after ovary removal.
➛ Psychological and emotional support groups.
➛ Physical therapy for mobility and pelvic health recovery.
10. Follow-up and Monitoring
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Pelvic exam and Pap test | if cervix retained.
Imaging | CT/MRI | if symptoms or recurrence suspected.
Monitoring hormone side effects and overall health.
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Pelvic exam and Pap test | if cervix retained.
Imaging | CT/MRI | if symptoms or recurrence suspected.
Monitoring hormone side effects and overall health.
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