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
- Head of Women's Cancers, Lifespan Cancer Institute
- Director of Medical Oncology, Rhode Island Hospital
- Associate Professor of Medicine, Warren Alpert Medical School of Brown University
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".)
- American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005; 106:413.
- Kimura T, Kamiura S, Yamamoto T, et al. Abnormal uterine bleeding and prognosis of endometrial cancer. Int J Gynaecol Obstet 2004; 85:145.
- Seebacher V, Schmid M, Polterauer S, et al. The presence of postmenopausal bleeding as prognostic parameter in patients with endometrial cancer: a retrospective multi-center study. BMC Cancer 2009; 9:460.
- Espindola D, Kennedy KA, Fischer EG. Management of abnormal uterine bleeding and the pathology of endometrial hyperplasia. Obstet Gynecol Clin North Am 2007; 34:717.
- Montgomery BE, Daum GS, Dunton CJ. Endometrial hyperplasia: a review. Obstet Gynecol Surv 2004; 59:368.
- Ronghe R, Gaudoin M. Women with recurrent postmenopausal bleeding should be re-investigated but are not more likely to have endometrial cancer. Menopause Int 2010; 16:9.
- http://seer.cancer.gov/statfacts/html/corp.html (Accessed on June 06, 2016).
- Reed SD, Newton KM, Clinton WL, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200:678.e1.
- 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.
- Wright TC Jr, Massad LS, Dunton CJ, et al. 2006 consensus guidelines for the management of women with abnormal cervical screening tests. J Low Genit Tract Dis 2007; 11:201.
- Vernooij F, Heintz P, Witteveen E, van der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol 2007; 105:801.
- Torres ML, Weaver AL, Kumar S, et al. Risk factors for developing endometrial cancer after benign endometrial sampling. Obstet Gynecol 2012; 120:998.
- Twu NF, Chen SS. Five-year follow-up of patients with recurrent postmenopausal bleeding. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:628.
- Larson DM, Johnson KK, Broste SK, et al. Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol 1995; 86:38.
- Frumovitz M, Singh DK, Meyer L, et al. Predictors of final histology in patients with endometrial cancer. Gynecol Oncol 2004; 95:463.
- Guidos BJ, Selvaggi SM. Detection of endometrial adenocarcinoma with the ThinPrep Pap test. Diagn Cytopathol 2000; 23:260.
- Schorge JO, Hossein Saboorian M, Hynan L, Ashfaq R. ThinPrep detection of cervical and endometrial adenocarcinoma: a retrospective cohort study. Cancer 2002; 96:338.
- Gu M, Shi W, Barakat RR, et al. Pap smears in women with endometrial carcinoma. Acta Cytol 2001; 45:555.
- Dash RC, Doud LG. Correlation of pap smear abnormalities in endometrial adenocarcinomas (Abstract). Acta Cytol 2001; 45:835.
- Heald B, Mester J, Rybicki L, et al. Frequent gastrointestinal polyps and colorectal adenocarcinomas in a prospective series of PTEN mutation carriers. Gastroenterology 2010; 139:1927.
- Riegert-Johnson DL, Gleeson FC, Roberts M, et al. Cancer and Lhermitte-Duclos disease are common in Cowden syndrome patients. Hered Cancer Clin Pract 2010; 8:6.
- Pilarski R, Stephens JA, Noss R, et al. Predicting PTEN mutations: an evaluation of Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome clinical features. J Med Genet 2011; 48:505.
- Tan MH, Mester JL, Ngeow J, et al. Lifetime cancer risks in individuals with germline PTEN mutations. Clin Cancer Res 2012; 18:400.
- http://www.nccn.org/professionals/physician_gls/pdf/genetics_screening.pdf (Accessed on January 18, 2012).
- 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