Endometrial cancer !
Endometrial cancer is a cancer of the lining of the uterus; it usually shows early as bleeding after menopause, which makes it often curable.
Updated 2026-10-29
Structures involved
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In histology
In the clinical exam
In physiology
Why it happens
- Hyperplasia: physiologic and pathologic
- Genomic instability: mismatch repair, BRCA and xeroderma pigmentosum
- From specimen to report: fixation, margins and the pathology report
- Obesity: leptin, adipokines and its consequences
- Cytology: the Pap test, fine-needle aspiration and body fluids
- Precancerous conditions: when chronic inflammation, metaplasia or hyperplasia raise the risk
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What it is
A malignant tumour arising from the lining of the uterus (endometrium). It usually presents early with postmenopausal bleeding, which makes it one of the more curable gynaecological cancers.
Who gets it
Mostly affects women after menopause, and its frequency is rising with obesity and longer life expectancy. In Colombia and Latin America the growing rates of obesity and diabetes increase its relevance.
Causes
- Long exposure to estrogen not balanced by progesterone
- Endometrial hyperplasia with atypia as a precursor of endometrioid cancer
- Inherited mismatch repair defects (Lynch syndrome)
- Non-estrogen-dependent serous and clear cell cancers, often in older women
Risk factors
- Obesity
- Diabetes and insulin resistance
- Polycystic ovary syndrome with infrequent ovulation
- Estrogen therapy without a progestogen, or tamoxifen
- Never having been pregnant, early menarche or late menopause
- Lynch syndrome
Pathophysiology
Unopposed estrogen drives endometrial proliferation, then hyperplasia and atypia, leading to endometrioid carcinoma. Other subtypes, such as serous carcinoma, arise from atrophic endometrium through TP53 mutations and spread early. The tumour invades the myometrium and cervix and spreads to pelvic and para-aortic nodes.
Classification
- Classic: type I (endometrioid, estrogen-related, lower grade) and type II (serous, clear cell, more aggressive)
- Molecular groups: POLE-mutated, mismatch repair–deficient, p53-abnormal and no specific molecular profile
- FIGO stages I–IV, by myometrial invasion, cervical, nodal and distant spread
Symptoms and signs
- Postmenopausal bleeding, the main presenting sign
- Heavy or irregular bleeding before menopause, especially after 45 or with risk factors
- Watery or blood-stained vaginal discharge
- Pelvic pain or mass in advanced disease
Diagnosis
- Clinical
- Every episode of postmenopausal bleeding is investigated. Pelvic examination looks for other bleeding sources and spread.
- Tests
- Endometrial biopsy (office aspiration or by hysteroscopy) gives the diagnosis; mismatch repair testing of the tumour screens for Lynch syndrome; complete blood count if bleeding is heavy.
- Imaging
- Transvaginal ultrasound measures endometrial thickness; a thin endometrium (a widely used cut-off is 4 mm or less) makes cancer unlikely in postmenopausal bleeding. MRI assesses invasion and CT looks for distant spread.
Differential diagnosis
- Endometrial atrophy
- Endometrial polyp
- Endometrial hyperplasia
- Cervical cancer
- Bleeding from hormone therapy
Goal of treatment
Remove the tumour and stage it accurately, then tailor additional therapy to the risk of recurrence.
Treatment
- Surgical
- Total hysterectomy with removal of both tubes and ovaries, usually by minimally invasive surgery, with sentinel node or lymph node assessment.
- Procedure
- Adjuvant radiotherapy (vaginal brachytherapy or pelvic external beam) according to risk group.
- Medical
- Chemotherapy, immunotherapy (especially in mismatch repair–deficient tumours) or hormonal therapy for advanced or recurrent disease.
- Medical
- Progestin therapy for selected young patients with early, low-grade disease who wish to preserve fertility.
Complications
- Recurrence in the vagina or pelvis
- Distant metastasis (lungs, liver, bone)
- Anaemia from bleeding
- Lymphoedema after node dissection
- Radiation effects on bladder and bowel
Prognosis
Most cases are found at stage I and have a good outlook. Prognosis is worse with high-grade or p53-abnormal tumours, deep invasion and spread beyond the uterus.
Prevention
- Maintaining a healthy weight and controlling diabetes
- Adding a progestogen to estrogen therapy in women with a uterus
- Combined hormonal contraception and the levonorgestrel intrauterine system are linked to lower risk
- Risk-reducing surgery may be discussed with women who have Lynch syndrome
Test yourself
Think of the answer, then tap the question to see it.
What is the typical presenting symptom of endometrial cancer?
Postmenopausal bleeding.
Why does obesity increase the risk of endometrial cancer?
Adipose tissue converts androgens into estrogen, giving prolonged estrogen exposure not balanced by progesterone.
Which test confirms the diagnosis of endometrial cancer?
Endometrial sampling with histology (office biopsy or hysteroscopic biopsy).
Which inherited syndrome links endometrial and colorectal cancer?
Lynch syndrome, caused by mismatch repair gene defects.
What is the precursor lesion of endometrioid endometrial cancer?
Endometrial hyperplasia with atypia (endometrial intraepithelial neoplasia).
Related conditions
- Abnormal uterine bleeding
- Polycystic ovary syndrome
- Obesity
- Type 2 diabetes mellitus
- Ovarian cancer
- Colorectal cancer
- Cervical cancer
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Endometrial Cancer (StatPearls (NCBI Bookshelf), 2024).
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