Endometrial cancer is a type of cancer that starts in the lining of the uterus, called the endometrium. It is the most common type of uterine cancer. Symptoms of endometrial cancer can include: Vaginal bleeding, especially after menopause Vaginal discharge Pelvic pain Pain during sexual intercourse Risk factors for endometrial cancer include: Age (most common in women over 60) Obesity Tamoxifen use Hormone replacement therapy (HRT) History of endometrial hyperplasia (a precancerous condition of the endometrium) Family history of endometrial cancer High blood pressure Polycystic ovary syndrome (PCOS) Diabetes Diagnosis of endometrial cancer is done through pelvic exam, ultrasound, and biopsy. The treatment of endometrial cancer depends on the stage of the cancer, but it can include surgery (total hysterectomy and removal of lymph nodes), radiation therapy, and chemotherapy. It's important to note that endometrial cancer is often curable when it is caught early. Therefore, it's important for women to be aware of the symptoms and risk factors, and to report any unusual changes to their healthcare provider. Additionally, women who have known risk factors should be followed up more closely.

1. ENDOMETRIAL
CANCER

2. Introduction
■ The most common gynecological cancer in the developed countries
■ Increasing in incidence
■ Life time risk is 1 in 46
■ The mean age of diagnosis is 62
■ Usually in old age, but 25% occur pre-menopause
■ Present in early stages

3. Classification
■ Most commonly adenocarcinoma (glandular component of the endometrium)

4. Etiology & Risk factor

5. Etiology & Risk factor
■ Unopposed estrogen : as in anovulation , PCO,….. Leading to endometrial
proliferation, hyperplasia and type 1 endometrial cancer
■ Obesity : aromatization of androgens to oestrogen by adipose tissue
■ Diabetes : insulin and insulin-like growth factor stimulate endometrial
proliferation
■ Tamoxifen: a selective oestrogen receptor modulator (SERM) ,act as estrogen
antagonist on breast and estrogen agonist on bone and endometrium
■ Hereditary : The most common association is with Lynch syndrome

6. Lynch syndrome
■ an autosomal dominant
■ caused by mutations in one of the mismatch repair genes MLH1, MSH2, MSH6
or, less commonly, PMS2.
■ The life-time risk of endometrial cancer in women with Lynch syndrome is 40–
60%.
■ Other tumour associations include colorectal, ovarian and urothelial tumours

7. Prevention and screening
■ OCP : protective
■ IUD : protective
■ Prophylactic hysterectomy in Lynch patients
■ No effective screening protocol

8. Clinical picture
■ The most common presentation is AUB (abnormal uterine bleeding ) , PMB in
menopaused and abnormal bleeding in premenopausal
■ Women at more advanced stages of disease present with abdominal pain, urinary
dysfunction, bowel disturbances or respiratory symptoms
■ Abnormal pap smear with glandular abnormality
■ Pelvic examination usually normal
■ History of endometrial hyperplasia (complex with atypia ) carries a risk of
progression to endometrial cancer 25-50 %

9. Staging ■ Staged clinically by CT , MRI

10. Management
■ The main stay treatment option is SURGERY
■ HYSTERECTOMY +BSOO
■ If stage 2 (cervix involved ) : modified radical hysterectomy
■ Radiotherapy : decrease recurrence , doesn’t improve survival , used for
advanced stages as stage 3
■ Chemotherapy : maybe given for advanced stages
■ Hormonal therapy : IUS maybe used in palliative treatment , unfit for surgery ,
hyperplasia without atypia , stage A1 fertility sparing (high failure rate )

11. Prognosis
■ The overall 5-year survival rate for endometrial cancer is 80%
■ Worse prognosis if : (type, stage, grade and nodal involvement )
 Advanced age
 grade 3 tumors
 type 2 histology
 deep myometrial invasion
 lymphovascular space invasion
 nodal involvement
 distant metastases.