Endometrial cancer

Endometrial cancer
Name	Endometrial cancer
Field	Oncology, Gynecology
Synonyms	Endometrial carcinoma, Uterine cancer

Endometrial cancer is a malignancy arising from the lining of the uterus that predominantly affects postmenopausal women and is a leading gynecologic cancer in many countries. It presents with a spectrum of clinical and molecular subtypes linked to hormonal, genetic, and environmental influences, and it is managed by multidisciplinary teams involving surgical, medical, and radiation oncology specialists. Understanding of this disease draws on research from institutions, trials, and guideline bodies worldwide to inform screening, staging, and treatment strategies.

Signs and symptoms

The most common presenting feature is abnormal uterine bleeding, particularly postmenopausal bleeding, which prompts evaluation by specialists associated with Mayo Clinic, Memorial Sloan Kettering Cancer Center, Johns Hopkins Hospital, Cleveland Clinic, and other tertiary centers. Other manifestations reported in case series from Massachusetts General Hospital, Addenbrooke's Hospital, Guy's and St Thomas' NHS Foundation Trust, Royal Marsden Hospital, and referral centers include pelvic pain, vaginal discharge, and palpable pelvic mass, with advanced disease causing urinary or bowel symptoms described in clinical reports from MD Anderson Cancer Center and Royal College of Obstetricians and Gynaecologists. Patterns of presentation and symptom recognition have been the subject of guidelines by organizations such as the American College of Obstetricians and Gynecologists, National Institute for Health and Care Excellence, and the European Society for Gynaecological Oncology.

Causes and risk factors

Epidemiologic cohorts from Framingham Heart Study, Nurses' Health Study, and population registries like SEER Program and Cancer Research UK implicate unopposed estrogen exposure, obesity, and metabolic syndrome as major risk factors. Endogenous and exogenous hormone influences have been examined in studies linked to Harvard T.H. Chan School of Public Health and World Health Organization reports; risk is elevated with nulliparity, early menarche, late menopause, and tamoxifen exposure documented in trials by Early Breast Cancer Trialists' Collaborative Group and oncology centers such as Institut Gustave Roussy. Genetic predisposition includes mismatch repair gene mutations associated with Lynch syndrome families studied at Dana-Farber Cancer Institute, University of Cambridge, and University of Toronto; rare syndromes described by geneticists at St. Mary's Hospital and academic consortia also contribute. Smoking, pelvic radiation exposure from treatments at institutions like Royal Brisbane and Women's Hospital, and certain hereditary clusters reported by registries such as International Agency for Research on Cancer have been evaluated.

Pathology and classification

Histopathologic classification follows work from pathology centers including The Royal College of Pathologists, College of American Pathologists, Karolinska Institutet, and landmark reviews published by researchers at MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center. Major types include endometrioid, serous, clear cell, and carcinosarcoma variants, each linked to distinct molecular features identified in consortia such as The Cancer Genome Atlas and translational groups at Broad Institute. Grading and features such as myometrial invasion, lymphovascular space invasion, and tumor histologic subtype are reported in pathology standards from World Health Organization classifications and consensus statements from International Federation of Gynecology and Obstetrics.

Diagnosis and staging

Diagnostic evaluation typically involves transvaginal ultrasound, endometrial biopsy, hysteroscopy, and cross-sectional imaging interpreted in centers like Guy's and St Thomas' NHS Foundation Trust, Royal Adelaide Hospital, and Vall d'Hebron University Hospital. FIGO staging, adopted internationally after consensus meetings involving FIGO panels and clinicians from University College London and University of Barcelona, relies on surgical-pathologic assessment. Sentinel lymph node mapping and lymphadenectomy techniques refined at Memorial Sloan Kettering Cancer Center, Mayo Clinic, and University of Southern California influence staging algorithms; PET-CT and MRI protocols developed at Mount Sinai Hospital and UCLA support preoperative assessment.

Treatment

Primary management often includes total hysterectomy with bilateral salpingo-oophorectomy performed by gynecologic oncologists trained at centers such as Royal Marsden Hospital, MD Anderson Cancer Center, and Memorial Sloan Kettering Cancer Center. Adjuvant approaches—radiation therapy, chemotherapy regimens including carboplatin and paclitaxel, and hormonal therapies like progestins—are guided by trials from cooperative groups including Gynecologic Oncology Group, European Organisation for Research and Treatment of Cancer, and National Comprehensive Cancer Network. Minimally invasive surgery, robotic approaches developed in programs at Intuitive Surgical partner hospitals, and fertility-sparing protocols for select patients have been described in reports from Cleveland Clinic and Mount Sinai Health System. Emerging treatments, including immune checkpoint inhibitors and targeted therapies informed by molecular profiling from The Cancer Genome Atlas and trials at Dana-Farber Cancer Institute, are under evaluation.

Prognosis and survival=

Prognostic factors identified in longitudinal studies from Surveillance, Epidemiology, and End Results Program, Cancer Research UK, and major cancer centers include stage at diagnosis, histologic subtype, grade, lymphovascular invasion, and molecular biomarkers characterized by groups at Broad Institute and Johns Hopkins University. Five-year survival rates vary widely; population-based survival analyses published by SEER Program and national registries in Australia, Canada, and across European Union countries provide comparative outcomes. Nomograms and risk models developed at MD Anderson Cancer Center and Mayo Clinic assist individualized prognostication.

Epidemiology

Incidence and mortality patterns reported by World Health Organization, Global Cancer Observatory, and national cancer registries such as SEER Program and Cancer Research UK show higher incidence in high-income countries, with rising rates linked to obesity trends documented by Centers for Disease Control and Prevention, Public Health England, and European Centre for Disease Prevention and Control. Age-specific incidence, racial and ethnic disparities reported by researchers at University of California, San Francisco, University of Chicago, and University of Texas reveal variations in survival and access to care analyzed in global health studies by World Bank and international collaborations.

Category:Gynaecological cancer