Endometrial carcinoma: Clinical features and diagnosis
- Lee-may Chen, MD
Lee-may Chen, MD
- Professor of Obstetrics, Gynecology, & Reproductive Sciences
- Division of Gynecologic Oncology
- UCSF Helen Diller Family Comprehensive Cancer Center
- Jonathan S Berek, MD, MMS
Jonathan S Berek, MD, MMS
- Laurie Kraus Lacob Professor
- Stanford University School of Medicine
- Fellow, Stanford Distinguished Careers Institute
- Director, Stanford Women's Cancer Center
- Senior Scientific Advisor, Stanford Cancer Institute
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
Uterine cancer is the most common gynecologic malignancy in developed countries and is the second most common in developing countries (cervical cancer is more common). Adenocarcinoma of the endometrium (lining of the uterus) is the most common histologic site and type of uterine cancer. (See "Endometrial carcinoma: Epidemiology and risk factors".)
Abnormal uterine bleeding is the cardinal symptom of endometrial cancer. Occasionally, women with endometrial cancer who have no abnormal uterine bleeding present with abnormal findings on cervical cytology. Seventy-five to 90 percent of women with endometrial carcinoma present with abnormal uterine bleeding [1-3]. The majority of patients are diagnosed with disease confined to the uterus and have a greater than 90 percent five-year survival rate.
The clinical features, diagnosis, and screening of women for endometrial cancer will be reviewed here. An overview of endometrial cancer can be found separately (see "Overview of endometrial carcinoma"). Related topics are discussed in detail separately, including:
●Histopathology and pathogenesis (See "Endometrial carcinoma: Histopathology and pathogenesis".)
●Epidemiology and risk factors (See "Endometrial carcinoma: Epidemiology and risk factors".)
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- Committee on Practice Bulletins—Gynecology. Practice bulletin no. 128: diagnosis of abnormal uterine bleeding in reproductive-aged women. Obstet Gynecol 2012; 120:197. Reaffirmed 2016.
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- CLINICAL PRESENTATION
- Abnormal uterine bleeding
- Cervical cytology findings
- Incidental finding on imaging
- Incidental finding at hysterectomy
- EVALUATION OF WOMEN WITH SUSPECTED ENDOMETRIAL NEOPLASIA
- Physical examination
- Laboratory evaluation
- Pelvic sonography
- Endometrial sampling
- DIFFERENTIAL DIAGNOSIS
- FURTHER EVALUATION AFTER ENDOMETRIAL SAMPLING
- Negative endometrial sampling
- - Office endometrial biopsy with insufficient endometrial cells
- - Persistent or recurrent bleeding
- Positive endometrial sampling
- - Staging and treatment
- - Postmenopausal women not on hormone therapy
- - Women with risk factors for Lynch syndrome
- ENDOMETRIAL CANCER SCREENING
- Women at average or increased risk
- Women with Lynch syndrome
- Other genetic syndromes
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS