Most common malignant diseases affecting the uterus is endometrial carcinoma, which arises from the lining of the uterus. However, sarcoma also arise from the stroma of the endometrium or from the myometrium.
The median age of presentation is just over 60 years of age, however it can occur in their 20s, but the vast majority of cases occur in women over 45 years of age. with less than 5 ％ diagnosed under 40 years of age ．
* Many of the factors are related to an increase in oestrogen levels.
* In post – menopausal period, the majority of circulating oestrogen is derived from aromatization of peripheral androgens. This conversion take place principally in adipose tissue. Also post – menopausal women with diabetes have increased oestrogen levels.
* Nulliparity and late menopause are both associated with increased risk of endometrial cancers, which may be explained by the prolonged oestrogenic effect on the endometrium.
* Women who use oral contraceptive or progesterone have up to a 50 % reduction in the incidence of endometrial cancer and protection lasts for many years after the discontinuation of these treatments. Cigarette smoking has also been associated with the reduced risk of endometrial cancer.
There is no effective screening programme ， but occasionally cervical smears contain endometrial cancer cells or double thickness endometrial ultrasonic thickness of 4mm or more indicates a need for endometrial sampling ．
Glandular hyperplasia of the endometrium are benign conditions that may produce symptoms clinically indistinguishable from early endometrial carcinoma. Some of hyperplasias, even though reversible, are considered premalignant lesions. Divided into:
1/ Hyperplasia without atypia
which is subdivided into either simple ( cystic ) hyperplasia and complex ( adenomatous ) hyperplasia.
2/ Hyperplasia with atypia, these hyperplasia are generally considered premalignant.
1 – About 75 – 80 % of women with endometrial carcinoma will present with postmenopausal bleeding . Sometimes bloody stain postmenopausal vaginal discharge may be associated with endometrial carcinoma.
2 – In premenopausal period, most women with endometrial carcinoma present with intermenstrual bleeding . Although 1/3 may present with heavy periods only.
Traditionally, post menopausal bleeding was investigated by a dilatation and curettage.
Fractional curettage : dilatation and fractional curettage is the definitive procedure for diagnosis of endometrial carcinoma. It should be performed with the patient under anesthesia and by first curetting the endocervical canal followed by dilatation of the canal and circumferential curettage of the endometrial cavity.