Endometriumkarzinom

<a data-tip="vjXAXy" id="L186642485eed7e5c2157bcaa37865b8f" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">Endometrial</a> cancer is the most common cancer of the female genital tract in the US, with a peak <a data-tip="U-bb9w" id="L7a84aafaca6fd10c609a496e38eab9b7" data-category="link" href="Population_health#Za75cae58612d57021fbad9a9bc842614" data-lxid="Js0sDh">incidence</a> between 55 and 64 years of age. It is divided into two types based on histological characteristics; type I cancers account for 80% of all <a data-tip="vjXAXy" id="L84b137a286e889d0deef063dd7ca02b4" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancers and are of endometrioid origin, while type II cancers primarily originate from serous or <a data-tip="kUXmWx" id="L7431d181ab1c1ff5f89d62076a0f0784" data-category="link" href="Renal_cell_carcinoma#Z309ac58bcb2057f29f10ad161593de32" data-lxid="Ki0Usf">clear cells</a>. Although several <a data-tip="b31HSg0" id="Ldd3b17b1c82cdf436d56adca9e008c66" data-category="link" href="Interpreting_medical_evidence#Zbc0d0ff153bc5c7a27589815d0c842fd" data-lxid="ps0LDh">risk factors</a> are associated with the development of <a data-tip="vjXAXy" id="L0d5d1382883c7b37962188610a3640f9" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancer, the most important of these is long-term exposure to unopposed <a data-tip="OTbIIG" id="Le10cc1c8b1f93734c62a3a9d3aa3c09a" data-category="link" href="Female_sex_hormones#Z9f773b700d306dca5a1f7c25325b2ece" data-lxid="uk0ppT">estrogen</a> levels, especially in type I cancer. Painless, <a data-tip="rrbfiE" href="Abnormal_uterine_bleeding#Ze161a8896a97dabd495438d345faf4d6" data-category="link" id="La2d6eb2f67adf95b8b8ef7cfdcbc6058" data-lxid="G80BL3">abnormal uterine bleeding</a> (<a data-tip="rrbfiE" href="Abnormal_uterine_bleeding#Ze161a8896a97dabd495438d345faf4d6" data-category="link" id="L9475f4ced9cc6f2c2d538ef8c36fca76" data-lxid="G80BL3">AUB</a>) is the main symptom and often manifests in the early stages of the disease. In later stages, <a href="Pelvic_pain#Ze50e8c9d44978e7bb6c4a7dc79c20d5b" data-category="link" id="L79e1ece8eaead07118a2b20a846213f9" data-lxid="y80d63">pelvic pain</a> and a palpable mass may be present. Most patients with suspected <a data-tip="vjXAXy" id="L8a53a8e90b40020b925248382784323f" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancer undergo <a data-tip="0XYe9n" id="L48e333d25932d742505f59c06c0f2e10" data-category="link" href="Diagnostic_procedures_in_gynecology#Z8d28dacdc3d7d2e1afe4a9fa445ef6b7" data-lxid="SN0y0g">transvaginal ultrasound</a> followed by an <a data-tip="THb6pE" id="Lae290aba7d7df9f17c7423ba844ab4fd" data-category="link" href="Endometrial_cancer#Z93cfd21f8ab46d45175998b816937850" data-lxid="0O0eIT">endometrial biopsy</a> to confirm the diagnosis; however, an <a data-tip="THb6pE" id="Lf4d7cdfdfa5c8bd02bc08aef89a65996" data-category="link" href="Endometrial_cancer#Z93cfd21f8ab46d45175998b816937850" data-lxid="0O0eIT">endometrial biopsy</a> may also be performed as the initial study. Additional imaging studies (e.g., CT, <a data-tip="8n0OEg" href="Magnetic_resonance_imaging#Zefb6206a3f821bf7e5942b654dc6f6cf" data-category="link" id="L5ffbf297474799e7d76379f0a59ad302" data-lxid="pN0LXg">MRI</a>, or <a data-phrasegroup-id="jeV_At0" data-category="bonus" class="api dictionary" data-content="PHA+QW4gaW1hZ2luZyB0ZWNobmlxdWUgdGhhdCBjb21iaW5lcyBhIFBFVCBzY2FuIGFuZCBhIENUIHNjYW4sIG9mdGVuIHVzaW5nIGJvdGggYSB0cmFjZXIgKGUuZy4sIEZHRCkgYW5kIGNvbnRyYXN0LiBUaGlzIHR5cGUgb2Ygc2NhbiBpcyBjb21tb25seSB1c2VkIGZvciBjYW5jZXIgZGlhZ25vc2lzLCBzdGFnaW5nLCBhbmQgZm9sbG93LXVwLCBhcyB3ZWxsIGFzIGJlZm9yZSBpbnZhc2l2ZSBwcm9jZWR1cmVzIChlLmcuLCBiaW9wc2llcywgc3VyZ2VyeSksIGFzIGl0IGNhbiBwcm92aWRlIGFjY3VyYXRlIG1lYXN1cmVtZW50cyBvZiBuZW9wbGFzdGljIGxlc2lvbnMuPC9wPg==" id="Lb3b24925ab2397b115e1b0192b0e97ef" data-source="Lb3b24925ab2397b115e1b0192b0e97ef" data-tip="jeV_At0">PET/CT scan</a>) may be ordered by a specialist for the detection of <a data-tip="IrXYiz" id="L6638e6c54fc92bdf1546e3d26d47a74b" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastases</a>. Treatment and surgical staging typically involve a total <a data-tip="CfaqoP" id="L1d66276738571b3af91ddf2f2d76c71f" data-category="link" href="Invasive_cervical_cancer#Zf3b2bb9c2a4b725967cc0b12ba4d1fa9" data-lxid="ZO0ZIT">hysterectomy</a> with bilateral <a data-phrasegroup-id="WBcP-e0" data-category="bonus" class="api dictionary" data-content="PHA+QSBzdXJnaWNhbCBwcm9jZWR1cmUgdG8gcmVtb3ZlIHRoZSBvdmFyeSBhbmQgZmFsbG9waWFuIHR1YmUgb24gb25lIG9yIGJvdGggc2lkZXMuPC9wPg==" id="Lb12f1c6f9e19308f2f024b1643e15bf0" data-source="Lb12f1c6f9e19308f2f024b1643e15bf0" data-tip="WBcP-e0">salpingo-oophorectomy</a>, <a data-phrasegroup-id="ldWvJ40" data-category="bonus" class="api dictionary" data-content="PHA+QSBzdXJnaWNhbCBwcm9jZWR1cmUgdGhhdCByZW1vdmVzIGVpdGhlciBzb21lIG9mIHRoZSBseW1waCBub2RlcyAocmVnaW9uYWwgbHltcGhhZGVuZWN0b215KSBvciBtb3N0L2FsbCBvZiB0aGUgbHltcGggbm9kZXMgY2VydGFpbiBhcmVhIChyYWRpY2FsIGx5bXBoYWRlbmVjdG9teSkuIFVzZWQgdG8gZXZhbHVhdGUgZm9yIHR1bW9yIG1ldGFzdGFzaXMuPC9wPg==" id="L65a09d3d9e3fd6b2c59816f96d1b2f3e" data-source="L65a09d3d9e3fd6b2c59816f96d1b2f3e" data-tip="ldWvJ40">lymphadenectomy</a>, and <a data-tip="3SbSzG" id="L684f67713fa91ba0e7e6e1e362ea4688" data-category="link" href="Abdominal_cavity#Z5cade66952c197c29b552666e2f95aef" data-lxid="LJ0wuS">peritoneal</a> washings. In patients with cancer confined to the <a data-tip="vjXAXy" id="Lfcdc3f0c647142702d197fa3d175f7d2" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrium</a> and <a data-tip="o_b06w" id="L71366e4dff3eb4402c41763e6ca9bb34" data-category="link" href="Female_reproductive_organs#Z7b228c95915b99127e75b4341fc65028" data-lxid="O60IOS">myometrium</a>, further treatment is generally not required; if cancer has advanced, <a id="Lee6ff6f6daee1f2d18213232d19dcca5" data-category="link" href="Surgery_clerkship#Za68e01313423572283ce418087f356cb" data-lxid="7I04Vh">surgery</a> is combined with <a data-tip="-L0DZS" href="Radiation_therapy#Zd120147b0e92bb22668d9e60dfbdc88b" data-category="link" id="Ldb0a6aaf53085c109fd0393936147eed" data-lxid="L50wkg">radiotherapy</a>, <a data-tip="ZKaZUl" id="L212f02523b997c0b9dc464c586c791fd" data-category="link" href="General_endocrinology#Zc880c21d5265a921cfdf80b444377952" data-lxid="AT0Rt2">hormone</a> therapy, and/or <a data-tip="ifbJNG" href="Chemotherapeutic_agents#Z4c7ae79c18cb3c2f3e1fa98185b2d78d" data-category="link" id="Lbd17360799835aa1328543dfee3a99d4" data-lxid="4m03fg">chemotherapy</a>. The prognosis is usually favorable in cancers diagnosed at an early stage.

Summary

<ul>
<li>
Type I endometrial cancer: endometrioid <a data-tip="cGXayz" id="L799a9f60a7b7025e66e74d1b31e0cc35" data-category="link" href="General_oncology#Zc01e9298ba3297914edcac57d8585d40" data-lxid="WM0Png">adenocarcinomas</a> (grade 1 and 2) derived from <a data-tip="-faDKP" id="L6b44b026a860f04b688a42dfbfac59ab" data-category="link" href="Benign_and_premalignant_lesions_of_the_endometrium#Za7be8ff2f96e2e4a52ac045b014c36c0" data-lxid="UJ0btS">atypical endometrial hyperplasia</a> [1][2]
</li> <li>
Type II endometrial cancer: endometrioid <a data-tip="cGXayz" id="L9e82df5e4fb9aa893f871d121dd37334" data-category="link" href="General_oncology#Zc01e9298ba3297914edcac57d8585d40" data-lxid="WM0Png">adenocarcinomas</a> (grade 3) and tumors of non­endometrioid <a id="Lb4b284a5e2e0343df877e072fde28231" data-category="link" href="General_histology#Z1f24d210123bdab6ab0bcb4489453103" data-lxid="Io0YWS">histology</a>; (serous, <a data-tip="kUXmWx" id="L562fc94e553f30b3a2fbf9d90affcaec" data-category="link" href="Renal_cell_carcinoma#Z309ac58bcb2057f29f10ad161593de32" data-lxid="Ki0Usf">clear cell</a>, <a data-phrasegroup-id="4QX3wB" data-category="bonus" class="api dictionary" data-content="PHA+QSBmYW1pbHkgb2YgcHJvdGVpbnMgdGhhdCBhcmUgY29tcG9zZWQgb2YgZ2x5Y29zeWxhdGVkIHBvbHlzYWNjaGFyaWRlcywgd2hpY2ggYWxsb3cgdGhlbSB0byBhYnNvcmIgd2F0ZXIgYW5kIGZvcm0gZ2VsLWxpa2Ugc2VjcmV0aW9ucy4gTXVjaW5zIGFyZSBmb3VuZCBpbiBwYXJ0aWN1bGFyIG9uIG11Y29zYWwgc3VyZmFjZXMgYW5kIHByb3ZpZGUgYSBwcm90ZWN0aXZlIGJhcnJpZXIsIGUuZy4sIHByZXZlbnRpbmcgY2hlbWljYWwgaW5qdXJ5IGZyb20gZ2FzdHJpYyBhY2lkLjwvcD4=" id="Lcf2a8189640ceaaa6135efd156573b37" data-source="Lcf2a8189640ceaaa6135efd156573b37" data-tip="4QX3wB">mucinous</a>, squamous, transitional, and undifferentiated cells) [2]
</li> </ul>

Definitions

Etiology

<ul>
<li>
<a data-tip="Dsa1CN" id="L2ec4ab64d76ccbe2b07ab7737dcba86d" data-category="link" href="Population_health#Z44a0fb80a8923b6e2fb8ff1f83d5803a" data-lxid="Js0sDh">Prevalence</a> [5][6] <ul>
<li class="condensed-hidden">
1–2% in the US <span class="api explanation" data-category="bonus" data-content="QXBwcm94LiA8c3BhbiBjbGFzcz0ibm93cmFwIj44MDAsMDAwIHdvbWVuPC9zcGFuPiBsaXZpbmcgaW4gdGhlIFVTIHdpdGggdXRlcmluZSBjYW5jZXIK" id="Ef03865960b5466d9a717410f28dd7f7b" data-tip=" ">
</li> <li>
The most common cancer of the female genital tract in the US [5]
</li> <li class="condensed-hidden">Fourth most common cancer in women (after <a href="The_breasts#Z1b473b16a0c304b8376bbf09eefde16e" data-category="link" id="L5cec83d78986e526f4558cd0eeabab86" data-lxid="B60zMS">breast</a>, <a href="Airways_and_lungs#Z5a964768554f93e7967999032fda236f" data-category="link" id="Lda6c069a3747d21061d1a7e57524d931" data-lxid="ap0QLS">lung</a>, and <a data-tip="s40tkT" href="Colorectal_cancer#Z5f9a21e2819d2a5004da275e0fe8e909" data-category="link" id="L9fa097a1a9d1381a9ad9ea1a43d12414" data-lxid="TS06_2">colorectal cancer</a>)</li> <li class="condensed-hidden">
<a id="L2153ee1667a55e9f4da133e34c32932b" data-category="link" href="Endometrial_cancer#Z1b9a85b8d9081f5e1b0245681b43f1d7" data-lxid="0O0eIT">Type I endometrial cancer</a> accounting for ∼ 80% of <a data-tip="vjXAXy" id="L8875bd9b350aeb247b896de27923a2ce" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancers, whereas <a id="L45981f13d2321ebf6932c3959a3761a1" data-category="link" href="Endometrial_cancer#Z7a1b4d25c990b3dc90df6dd07c98fd40" data-lxid="0O0eIT">type II endometrial cancer</a> comprise 10–20% of cases [2]
</li> </ul>
</li> <li class="condensed-hidden">
<a data-tip="U-bb9w" id="L25a7658e593db14b493c18b91602f5a0" data-category="link" href="Population_health#Za75cae58612d57021fbad9a9bc842614" data-lxid="Js0sDh">Incidence</a>: ∼ 20–28 per 100,000 women per year [5]
</li> <li>
Age [5] <ul>
<li>Primarily affect <a data-tip="XSa9yP" id="L3ea822d2f396b25c78d0ddddf18a4af8" data-category="link" href="Menopause#Z028440e5b47771796d4ba443d65fad68" data-lxid="BO0zuT">postmenopausal</a> women</li> <li>
Peak <a data-tip="U-bb9w" id="Lbe3fb0cdd87b854edbbe6aa9eddcd2e3" data-category="link" href="Population_health#Za75cae58612d57021fbad9a9bc842614" data-lxid="Js0sDh">incidence</a>: 55–64 years <span class="api explanation" data-category="bonus" data-content="VGhlIGF2ZXJhZ2UgYWdlIGF0IGRpYWdub3NpcyBpcyA8c3BhbiBjbGFzcz0ibm93cmFwIj42MyB5ZWFyczwvc3Bhbj4sIHRob3VnaCA8c3BhbiBjbGFzcz0ibm93cmFwIj7iiLwgMjDigJMyNSU8L3NwYW4+IG9mIHdvbWVuIGFyZSBkaWFnbm9zZWQgYmVmb3JlIDxhIGRhdGEtdGlwPSJZU2FueVAiIGhyZWY9Ik1lbm9wYXVzZSNaMDE3N2VkZGVjNjNjMjQ1ZjUwNmVmMmJjMGUwOTM3NWQiIGRhdGEtY2F0ZWdvcnk9ImxpbmsiIGlkPSJMMzNmZGQwYmRlZDkzODJjNjc5ZWQ5NGJmZjZiOGQ0ZmQiIGRhdGEtbHhpZD0iQk8wenVUIj5tZW5vcGF1c2U8L2E+Lgo=" id="Ec0b9aac3a3e27b71ca9b89e7cb0ab16f" data-tip=" "> <ul class="condensed-hidden">
<li>Onset of type I cancer is usually nearer to <a data-tip="YSanyP" href="Menopause#Z0177eddec63c245f506ef2bc0e09375d" data-category="link" id="L7fedf6142be2330220a5bf8f1d7f4808" data-lxid="BO0zuT">menopause</a>
</li> <li>
Type II cancer typically occurs in women who are older, with the mean age of diagnosis being 67 years.</li> </ul>
</li> </ul>
</li> </ul>Epidemiological data refers to the US, unless otherwise specified.

Epidemiology

<h2 id="Yb53ed06d221bf2113f19eea4374c64f8">Localized disease [4]
</h2> <ul>
<li>
<a data-tip="rrbfiE" href="Abnormal_uterine_bleeding#Ze161a8896a97dabd495438d345faf4d6" data-category="link" id="Ld27e1260163d087e54cf3d49247225d6" data-lxid="G80BL3">Abnormal uterine bleeding</a> (<a data-tip="rrbfiE" href="Abnormal_uterine_bleeding#Ze161a8896a97dabd495438d345faf4d6" data-category="link" id="Ld6d71fb0449930b7a7a4131130ba283f" data-lxid="G80BL3">AUB</a>) <ul>
<li>
<a data-tip="XSa9yP" id="Ld4fd9094cecc16efacc7d608f553255c" data-category="link" href="Menopause#Z028440e5b47771796d4ba443d65fad68" data-lxid="BO0zuT">Postmenopausal</a>: any amount of bleeding, including spotting
</li> <li>
<a data-tip="cSaaAP" id="L758cbf26e94ac59a4b2881a322bb316f" data-category="link" href="Menopause#Z2288200fd1105ba221b2adb4a5080961" data-lxid="BO0zuT">Premenopausal</a> or <a data-tip="bSaHyP" id="Lfa378d768d0b6512802f5e111f659ae8" data-category="link" href="Menopause#Z4905b81ddbe89e29dbc3170d7240cd9c" data-lxid="BO0zuT">perimenopausal</a> ; <span class="api explanation" data-category="bonus" data-content="RHVyaW5nIHRoZSA8YSBkYXRhLXRpcD0iYlNhSHlQIiBocmVmPSJNZW5vcGF1c2UjWjQ5MDViODFkZGJlODllMjlkYmMzMTcwZDcyNDBjZDljIiBkYXRhLWNhdGVnb3J5PSJsaW5rIiBpZD0iTDQyNTlkMTRhY2JjYWVhOTQ1NTA5NGM3MjBjZjNjMTg4IiBkYXRhLXNlY3Rpb24taWQ9ImdQYkZWRiIgZGF0YS1seGlkPSJCTzB6dVQiPnBlcmltZW5vcGF1c2FsPC9hPiBwaGFzZSwgbWVuc3RydWFsIGJsZWVkaW5nIGdyYWR1YWxseSByZWR1Y2VzIGluIGxlbmd0aCBhbmQgYW1vdW50IGFzIHRoZSA8YSBkYXRhLXRpcD0iYlNhSHlQIiBocmVmPSJNZW5vcGF1c2UjWjQ5MDViODFkZGJlODllMjlkYmMzMTcwZDcyNDBjZDljIiBkYXRhLWNhdGVnb3J5PSJsaW5rIiBpZD0iTGE4ZTQ3ZTFjZWExZWFjNTg5YWEzOGRkZmE5ZTVhYWNkIiBkYXRhLXNlY3Rpb24taWQ9ImdQYkZWRiIgZGF0YS1seGlkPSJCTzB6dVQiPm1lbm9wYXVzYWwgdHJhbnNpdGlvbjwvYT4gcHJvZ3Jlc3NlczsgaG93ZXZlciwgZm9yIG1hbnkgd29tZW4sIGN5Y2xlcyBtYXkgYmVjb21lIGluY3JlYXNpbmdseSBpcnJlZ3VsYXIgaW4gZnJlcXVlbmN5IGFuZCBoZWF2aW5lc3MuCg==" id="E79a3b5d4efe51ffae2642b753d0fd3fd" data-tip=" "> [7] <ul>
<li><a data-tip="y2ad4P" id="L4ce264d49462fca84d94239205cc2400" data-category="link" href="Abnormal_uterine_bleeding#Z105297e56b312d89b51f2345e85b91b6" data-lxid="G80BL3">Intermenstrual bleeding</a></li> <li><a data-tip="A2aR4P" id="La54272dd4e07c6d8f79f3b6fc95f60be" data-category="link" href="Abnormal_uterine_bleeding#Z41bbf8cd7be1141103cd14443b95a8a1" data-lxid="G80BL3">Heavy irregular menstrual bleeding</a></li> </ul>
</li> </ul>
</li> <li>
<a data-tip="q8WCnM0" id="L5206c4eb432e7f1997737230928c5a47" data-category="link" href="OB/GYN:_history_and_physical_examination#Z6172909bf6c18e4379fe5eda2b6149c6" data-lxid="1r02Th">Pelvic exam</a> is often normal (<a id="L03b725ae7ad08d1d76e81ecd900772cc" data-category="link" href="Female_reproductive_organs#Za01eee7dd508a9ffebff19996b63507a" data-lxid="O60IOS">uterus</a> may be enlarged)
</li> </ul>
The majority of <a data-tip="vjXAXy" id="Le72905d2eba46e02d6e291febd847328" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancers are diagnosed at an early stage and have a good prognosis. [4] <h2 id="Y8214fc0e00fb1ebfdbb2b5cb89412196">Regional extension [4][8]
</h2> <ul>
<li><a href="Pelvic_pain#Ze50e8c9d44978e7bb6c4a7dc79c20d5b" data-category="link" id="L118d50dbcc7b130338275640401ea933" data-lxid="y80d63">Pelvic pain</a></li> <li class="condensed-hidden">Vaginal mass and/or bleeding</li> <li class="condensed-hidden">Abnormalities on <a data-tip="NsX-Ez" id="L1a04ca3aeb7aa464bfc6fd6397d6d144" data-category="link" href="Female_reproductive_organs#Zcbc35556e6d59e81460e41d87b9a0849" data-lxid="O60IOS">cervix</a>
</li> <li class="condensed-hidden">Abdominal distension</li> <li class="condensed-hidden">Changes in bowel and/or <a id="Lcc283ad9ddfef7655670304e535034eb" data-category="link" href="Overview_of_the_urinary_tract#Zb39fa0c160d5f2d2d45d0f06da0f4fcf" data-lxid="Rp0l6S">bladder</a> function</li> </ul>
<a data-tip="vjXAXy" id="Lc0214de5c1eec391c9f704fc2f8155bc" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">Endometrial</a> cancer may have both locoregional extension and contiguous spread to the <a data-tip="NsX-Ez" id="Lae3e7d3f951abdcc3d5d2c19f413c58a" data-category="link" href="Female_reproductive_organs#Zcbc35556e6d59e81460e41d87b9a0849" data-lxid="O60IOS">cervix</a>, <a data-tip="PsXWEz" id="L82d14ec33877f1e82084b397836bb6f9" data-category="link" href="Female_reproductive_organs#Zd08155e24a46d6bbdac6c849cd26564f" data-lxid="O60IOS">vagina</a>, <a data-tip="wjXhcy" id="L7b7a03a8434ba654c3459ff9e09ed70b" data-category="link" href="Female_reproductive_organs#Zdda587e1adfeb671d19fcb4b97b1d468" data-lxid="O60IOS">fallopian tubes</a>, and/or <a data-tip="jsX_uz" id="L7230ba0d96df1283571ad93d55bc4604" data-category="link" href="Female_reproductive_organs#Z5e0d00bc7c0a8697361ccaab0a159a4e" data-lxid="O60IOS">ovaries</a>. [8] <h2 id="Yf4821afb59b65b2fad6c1b33ffacf578" class="condensed-hidden">
<a data-tip="IrXYiz" id="L4ce4444c334ee61e612a8d357eca8597" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">Metastatic</a> disease [4][8]
</h2> <ul class="condensed-hidden">
<li>Lymphogenic <span class="api explanation" data-category="bonus" data-content="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" id="E85a4e821fd91523b512ed29c6466103e" data-tip=" "> and hematogenous <span class="api explanation" data-category="bonus" data-content="UmFyZSwgY2FuIG9jY3VyIGluIGFkdmFuY2VkIGRpc2Vhc2UsIGFuZCBpcyB1c3VhbGx5IHRvIHRoZSA8YSBocmVmPSJBaXJ3YXlzX2FuZF9sdW5ncyNaNWE5NjQ3Njg1NTRmOTNlNzk2Nzk5OTAzMmZkYTIzNmYiIGRhdGEtY2F0ZWdvcnk9ImxpbmsiIGlkPSJMMDNhNTRkZTllMDc5MmU3MTBhNTRhNzU5OGQ5ZDFkYTAiIGRhdGEtbHhpZD0iYXAwUUxTIj5sdW5nczwvYT4K" id="E40e72df55b1b7c37d993e1c303d9d0c6" data-tip=" "> <a data-tip="IrXYiz" id="L540be8425dd48ed0ddcbd39850e127da" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastases</a> can be seen in advanced stages of <a data-tip="vjXAXy" id="Lafec67a45386f03541d2153885746c5d" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancer. [8]
</li> <li>Patients may have nonspecific features: e.g., weight loss, <a data-tip="Wb1Ps20" id="Ld98956322507fd1596359f4911178e92" data-category="link" href="Mental_status_examination#Z77c4f329d4e1028bea9901be93bbe0ca" data-lxid="br0Hfh">lethargy</a>
</li> <li>Other features depend on the site of <a data-tip="IrXYiz" id="Lab5635a0e1640eed770b2039270e0c97" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastasis</a> and may include: <ul>
<li>Symptoms of <a data-tip="J2Xsix" id="L3af1fadfebc125a3e6d5126dd0b5ad89" data-category="link" href="General_oncology#Z843d0dd84a48939f1c85f497820c09c1" data-lxid="WM0Png">mass effect</a>
</li> <li><a href="Cough#Z53178f74af701c6933574f4f111d6391" data-category="link" id="L98518cf0ddcf31a755549c0d8dbef308" data-lxid="3L0Sxg">Cough</a></li> <li><a data-tip="1o02aS" href="Pleural_effusion#Z4f6cc81490f80454657181033c0f0214" data-category="link" id="L014871d274a52bd7e4a7b1203e760f56" data-lxid="F50gNg">Pleural effusion</a></li> </ul>
</li> </ul>

Clinical features

Transvaginal ultrasound (longitudinal and transverse planes)
The endometrium appears thickened. Compared to the surrounding myometrium, an iso-hyperechoic lesion can be seen (green overlay), which invades &lt; 50% of the myometrium.
These findings suggest endometrioid adenocarcinoma. A biopsy is required to confirm the diagnosis.

Endometrioid adenocarcinoma

Transvaginal ultrasound of a postmenopausal woman with a history of intermittent vaginal discharge
A 2.5 x 3.3 cm hypoechoic fluid collection (hydrometra) is seen. Portions of the endometrium are not clearly delineated and a small area of thickening is seen (green overlay). The findings are concerning for endometrial carcinoma, which was subsequently confirmed by biopsy.
The normal postmenopausal endometrium is thin, homogeneous, and echogenic. Endometrial fluid collections in postmenopausal women have been associated with various conditions, among them endometrial carcinoma, endometrial hyperplasia, endometrial polyp, hormone replacement therapy, and cervical stenosis.
C: cervix; U: uterine wall

Endometrial fluid in endometrial carcinoma

Photomicrograph of a uterine tissue specimen (H&amp;E stain; low magnification)
Residual normal endometrium is shown in the upper central portion of the image (yellow dashed outline). In the lower half of the image, atypical confluent glands (yellow overlay) and areas of necrosis (indicated by arrowheads) are seen. Additionally, solid tumor areas with loss of glandular formations are present (black overlay). The glands show invasion into the myometrium (white overlay), which typically includes large myometrial arteries (blue overlay).
These findings indicate uterine carcinoma. Definite diagnosis of endometrioid differentiation should be performed via immunohistochemical stains (estrogen and progesterone receptor expression, vimentin positivity, weak to negative p16).

Endometrioid adenocarcinoma (1/3)

Photomicrograph of a uterine tissue specimen (H&amp;E stain; intermediate magnification)
Irregular glands (examples indicated by yellow overlay) are seen scattered throughout the smooth muscle tissue of the myometrium (blue arrowheads), indicating infiltrative growth. Fusion of glands (blue overlay), cribriform growth patterns (blue outline), and luminal necrotic material (examples indicated by black arrowheads) are also apparent.
These findings indicate uterine carcinoma. Definite diagnosis of endometrioid differentiation should be performed via immunohistochemical stains (estrogen and progesterone receptor expression, vimentin positivity, weak to negative p16).

Endometrioid adenocarcinoma (2/3)

Photomicrograph of a uterine tissue sample (H&amp;E stain; high magnification)
Fused atypical glands (yellow outline) are seen invading the myometrium (white overlay). The glands are composed of mainly columnar epithelial cells with eosinophilic cytoplasm (examples indicated by yellow overlay). The nuclei are enlarged with a vesicular chromatin pattern (examples indicated by yellow arrowheads). Also, the nuclei are unevenly distributed within the epithelium, i.e., some are located at the basal cell pole (normal arrangement within endometrium; examples indicated by blue arrowheads), while others are found at the apical pole (examples indicated by black arrowheads).
These findings indicate uterine carcinoma. Definite diagnosis of endometrioid differentiation should be performed via immunohistochemical stains (estrogen and progesterone receptor expression, vimentin positivity, weak to negative p16).

Endometrioid adenocarcinoma (3/3)

Diagnosis

Gross hysterectomy specimen
Tumor growth arising in the endometrium is invading slightly more than half of the myometrium (red overlay) in thickness. The tumor (green overlay) has spread to near the isthmus region but has not invaded the cervical stroma (blue overlay).
These findings are consistent with FIGO stage Ib endometrioid adenocarcinoma.

Pathology

<div class="table-wrapper"><table class="api">
<thead>
<tr>
<th colspan="2" scope="row"> 2023 <a data-phrasegroup-id="OQ0Iwf" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBGSUdPPC9pPg==" id="Ld3222df25d1082d56fc151eb7fb10a72" data-source="Ld3222df25d1082d56fc151eb7fb10a72" data-tip="OQ0Iwf">International Federation of Gynecology and Obstetrics</a> (<a data-phrasegroup-id="OQ0Iwf" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBGSUdPPC9pPg==" id="L6bf05d339d4cbbed7a118947f9ac7a4f" data-source="L6bf05d339d4cbbed7a118947f9ac7a4f" data-tip="OQ0Iwf">FIGO</a>) surgical <a id="L7dbf7bcdcffc9f79b176d4b398f03e64" data-category="link" href="Endometrial_cancer#Z24c959fe616d8bd4d104acd0b6c92aa4" data-lxid="0O0eIT">staging of endometrial cancer</a> [23]</th> </tr>
<tr>
<th scope="row"><a data-phrasegroup-id="OQ0Iwf" data-category="bonus" class="api dictionary" data-content="PGk+QWJicmV2aWF0aW9uOiBGSUdPPC9pPg==" id="L1ffb8148bab747ca3de24bac48fc7d1c" data-source="L1ffb8148bab747ca3de24bac48fc7d1c" data-tip="OQ0Iwf">FIGO</a> stage</th> <th scope="col">Anatomical involvement</th> </tr>
</thead>
<tbody>
<tr>
<th scope="row">I</th> <td> <ul>
<li>Limited to the <a data-tip="vjXAXy" id="Lb6e92fb9a9d1939b079fdfcb6aea7ac7" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrium</a> and <a data-tip="o_b06w" id="Lc9ad1a5c6aa055c3df799c07aa6859c0" data-category="link" href="Female_reproductive_organs#Z7b228c95915b99127e75b4341fc65028" data-lxid="O60IOS">myometrium</a> or <a data-tip="jsX_uz" id="Lb704983bd14c373ddbfd313128be4363" data-category="link" href="Female_reproductive_organs#Z5e0d00bc7c0a8697361ccaab0a159a4e" data-lxid="O60IOS">ovary</a> <ul>
<li>IA: limited to the <a data-tip="vjXAXy" id="L81bb9ec78b7a33411c8e8cb4598b05b7" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrium</a> OR non-aggressive <a id="L9390cf8f933e243df308840fff260490" data-category="link" href="General_histology#Z1f24d210123bdab6ab0bcb4489453103" data-lxid="Io0YWS">histology</a> OR good prognostic type</li> <li>IB: non-aggressive <a id="Lfdfe800f36c65eb67c9262cac171ce51" data-category="link" href="General_oncology#Z333a818dbf71a509f924e54006a41fb6" data-lxid="WM0Png">tumor</a> infiltrates ≥ half of the <a data-tip="o_b06w" id="Lc4123f7de769280fb2ecdae774458725" data-category="link" href="Female_reproductive_organs#Z7b228c95915b99127e75b4341fc65028" data-lxid="O60IOS">myometrium</a> </li> <li>IC: aggressive <a id="Lff7c5c4c2d6d5bb19d8b3ee8be48ac29" data-category="link" href="General_histology#Z1f24d210123bdab6ab0bcb4489453103" data-lxid="Io0YWS">histology</a> but disease limited to <a data-tip="vjXAXy" id="L6223f73f5a400029cbab60836f1c4689" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrium</a> or a polyp</li> </ul>
</li> </ul>
</td> </tr>
<tr>
<th scope="row"> II </th> <td> <ul>
<li>IIA: Infiltration of the <a data-tip="NsX-Ez" id="Laa2eecbaabc75e658968f811726f70c6" data-category="link" href="Female_reproductive_organs#Zcbc35556e6d59e81460e41d87b9a0849" data-lxid="O60IOS">cervix</a> with no evidence of extrauterine extension</li> <li>IIB: Extensive lymphovascular space involvement</li> <li>IIC: aggressive <a id="L75fb98fed7ffd54904aac9d7b7095792" data-category="link" href="General_histology#Z1f24d210123bdab6ab0bcb4489453103" data-lxid="Io0YWS">histology</a> in a cancer that has invaded <a data-tip="o_b06w" id="Lffc8386eb3ce73bca326aa78f8ee5b07" data-category="link" href="Female_reproductive_organs#Z7b228c95915b99127e75b4341fc65028" data-lxid="O60IOS">myometrium</a>
</li> </ul>
</td> </tr>
<tr>
<th scope="row"> III </th> <td> <ul>
<li>IIIA: <a id="Lc1cc504d9a2a297901e8fcce1ba95052" data-category="link" href="General_oncology#Z333a818dbf71a509f924e54006a41fb6" data-lxid="WM0Png">tumor</a> invades the serosa of the uterine body and/or the adnexa (direct spread or <a data-tip="IrXYiz" id="L86367a46d128a0c9e47a1e7df2505c64" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastasis</a>)</li> <li>IIIB: involvement of the <a data-tip="PsXWEz" id="L223a6fe04441f1070ebb34d222a7e0f0" data-category="link" href="Female_reproductive_organs#Zd08155e24a46d6bbdac6c849cd26564f" data-lxid="O60IOS">vagina</a> and/or the parametria or <a data-tip="ZyXZd00" id="L81f0de95ad389d544274f499534eb06a" data-category="link" href="Pelvis_and_hip_joint#Z302395fa53b6096eda0d6a50e247fdd4" data-lxid="A60RnS">pelvic</a> <a data-tip="3SbSzG" id="La997112b61e74aff5e50583060adccb2" data-category="link" href="Abdominal_cavity#Z5cade66952c197c29b552666e2f95aef" data-lxid="LJ0wuS">peritoneum</a> (direct spread or <a data-tip="IrXYiz" id="L94f77b0b94c454cf00dec02812958d36" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastasis</a>)</li> <li>IIIC: <a data-tip="IrXYiz" id="L38d7e4eb77a5cf505be9ba64fcc31b11" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastasis</a> in the <a data-tip="ZyXZd00" id="L8105cdf318e6fab2a645a121a7c11a59" data-category="link" href="Pelvis_and_hip_joint#Z302395fa53b6096eda0d6a50e247fdd4" data-lxid="A60RnS">pelvic</a> and/or <a data-tip="9SXNbB" id="L0ccb19d6a99bf99ef2b5eacead931dd0" data-category="link" href="Lymphatic_system#Zfca7d8fbadba573da7d7083555bb2b1c" data-lxid="960NMS">paraaortic lymph nodes</a>
</li> </ul>
</td> </tr>
<tr>
<th scope="row"> IV </th> <td> <ul>
<li>IVA: infiltration of the extragenital organs (<a id="Lb60806559795b5196085056114c4e8fb" data-category="link" href="Overview_of_the_urinary_tract#Zb39fa0c160d5f2d2d45d0f06da0f4fcf" data-lxid="Rp0l6S">bladder</a> or bowel)</li> <li>IVB: <a data-tip="YgbnFG" id="Lb14b15f59872adefb03edebe35ce4957" data-category="link" href="Colorectal_cancer#Z308dcf5539d19f810cbb10d7cd86dfd4" data-lxid="TS06_2">peritoneal metastases</a> extending beyond the <a data-tip="ZyXZd00" id="L05e3a6f4b88cf6257820a906683556e0" data-category="link" href="Pelvis_and_hip_joint#Z302395fa53b6096eda0d6a50e247fdd4" data-lxid="A60RnS">pelvis</a>
</li> <li>
<a data-phrasegroup-id="8RdOKp0" data-category="bonus" class="api dictionary" data-content="PHA+QW4gYWJicmV2aWF0aW9uIHRoYXQgY2FuIHJlZmVyIHRvOjxicj4NCjEuIEluZmVyaW9yIHZlbmEgY2F2YTxicj4NCjIuIEluc3BpcmF0b3J5IHZpdGFsIGNhcGFjaXR5PC9wPg==" id="L335b61d644299af1af8b768c87d579d4" data-source="L335b61d644299af1af8b768c87d579d4" data-tip="8RdOKp0">IVC</a>: distant <a data-tip="IrXYiz" id="Lf84b1f0cf2a6b3615d020a535ff58073" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">metastases</a>
</li> </ul>
</td> </tr>
</tbody>
</table></div>

Staging

<ul class="condensed-hidden">
<li>
Patients of any age [9][24] <ul>
<li><a data-tip="7P04TT" href="Hemostasis_and_bleeding_disorders#Z5a3cc6f90267ccb75d4d2c02be76da5a" data-category="link" id="Lbde00d438b4a04b2537a788d67d27878" data-lxid="8T0Os2">Coagulopathy</a></li> <li>Polyps</li> <li>Other malignancies of the reproductive tract, e.g., <a data-tip="lM0vKg" href="Invasive_cervical_cancer#Zb0043b20d16c82430e1686560be81736" data-category="link" id="L6a86b53796b07f63ea9c52fa65ba72d1" data-lxid="ZO0ZIT">cervical cancer</a>, <a data-tip="0cWea40" href="Ovarian_cancer#Z45675c72c419aa88af606896fcf0336d" data-category="link" id="L22af0bad0d8584cf832cd8a55898b483" data-lxid="aO0QIT">ovarian cancer</a>
</li> <li>
<a href="Benign_and_premalignant_lesions_of_the_endometrium#Z5ad3b5fa325f7d61ad547437b2b013fa" data-category="link" id="Lc1a68321605c098ad22cd4db8cd1b243" data-lxid="UJ0btS">Benign and premalignant lesions of the endometrium</a> including <a data-tip="cHba6E" id="L1352fe9988d260ecf900ffe74f002bd6" data-category="link" href="Benign_and_premalignant_lesions_of_the_endometrium#Z0ca58253632bb757248bb5b4a3244d40" data-lxid="UJ0btS">endometrial hyperplasia</a>
</li> <li><a data-tip="qyaCTM" href="Pelvic_inflammatory_disease#Zdd4153695a33d3bde24221a207781b44" data-category="link" id="Ld682401aab882399b8d911465cc7537a" data-lxid="pL0LAg">Pelvic inflammatory disease</a></li> <li>
<a data-tip="Qh0udf" id="L48210653402d434bcc4fd4d6eaf4e918" data-category="link" href="Hospital-acquired_infections#Zc74719fbc35d81e58337f58d0d2a90b6" data-lxid="_f05K2">Iatrogenic</a> <a id="L7a05ba1ceadcb554ed27715a9201175b" data-category="link" href="Abnormal_uterine_bleeding#Z70956cb0d948d6fc8d8475eea018823d" data-lxid="G80BL3">causes of abnormal uterine bleeding</a>, e.g., <a data-tip="vQ0ABf" id="L90e45a4de6d0379095d150544bdae83c" data-category="link" href="Oral_anticoagulants#Z868d6a2028d5c175da17ef6f1dc97b5a" data-lxid="Tm06Ug">anticoagulants</a>, <a data-phrasegroup-id="X7Y94q" data-category="bonus" class="api dictionary" data-content="PHA+QSBkZXNjcmlwdG9yIGZvciBhIGZhY3RvciB0aGF0IG9yaWdpbmF0ZXMgZnJvbSBvciBpcyBwcm9kdWNlZCBvdXRzaWRlIG9mIGFuIG9yZ2FuL29yZ2FuaXNtIChlLmcuLCBleG9nZW5vdXMgY29ydGlzb2wsIGV4b2dlbm91cyByaXNrIGZhY3RvcnMpLjwvcD4=" id="L8901678e61d9fd18aa4b15039fd8248f" data-source="L8901678e61d9fd18aa4b15039fd8248f" data-tip="X7Y94q">exogenous</a> <a data-tip="ZKaZUl" id="L6eb4e19951f27a710d51175b7502990b" data-category="link" href="General_endocrinology#Zc880c21d5265a921cfdf80b444377952" data-lxid="AT0Rt2">hormones</a>
</li> </ul>
</li> <li>
<a data-tip="cSaaAP" id="L67902cc0c48b4765cfc5ceeb3fb51b50" data-category="link" href="Menopause#Z2288200fd1105ba221b2adb4a5080961" data-lxid="BO0zuT">Premenopausal</a> patients and <a data-tip="bSaHyP" id="L6dddc37c6356ac55e7a943e999a57fa7" data-category="link" href="Menopause#Z4905b81ddbe89e29dbc3170d7240cd9c" data-lxid="BO0zuT">perimenopausal</a> patients [9][24] <ul>
<li><a data-tip="kM0mKg" href="Uterine_leiomyoma#Zc5eb4b89597eb0e0329630b79f996291" data-category="link" id="Lc669e3ca4589c750840509737e7b610a" data-lxid="zk0rqT">Uterine leiomyoma</a></li> <li><a data-tip="Nfa-mP" href="Adenomyosis#Z846f6453625c21d31f793dc8bdb80027" data-category="link" id="L9644722c13d7cacb406f474c8948d0b9" data-lxid="tE0Xx3">Adenomyosis</a></li> <li>Ovulatory dysfunction</li> </ul>
</li> <li>
<a data-tip="XSa9yP" id="L87d05854e640f1b9a2c05e2a02651713" data-category="link" href="Menopause#Z028440e5b47771796d4ba443d65fad68" data-lxid="BO0zuT">Postmenopausal</a> patients: <a data-tip="vjXAXy" id="Le265a82daae09e1aeee37d0dde762be5" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> or <a data-tip="rpdfII0" id="L51fa46a89780a76ff2e370020c66e793" data-category="link" href="Menopause#Zb979fe86ac4bca1ec197b7173ebd17d6" data-lxid="BO0zuT">vulvovaginal atrophy</a> [25]
</li> </ul>
The differential diagnoses listed here are not exhaustive.

Differential diagnoses

Treatment

<ul>
<li>Follow-up visits should occur: [4] <ul>
<li>Every 3–6 months for the first 2 years </li> <li>Every 6 months for the next 3 years </li> <li>Then annually</li> </ul>
</li> <li>At each visit obtain: [4] <ul>
<li>A thorough history including inquiring after new symptoms (e.g., <a href="Vaginal_bleeding#Z0ca9c1dda5e628509d7adc8e404c8f95" data-category="link" id="L00a38e353455099a77ff36af09d792cc" data-lxid="oH00rh">vaginal bleeding</a>, lower abdominal <a id="L2923913ae17d89ed1e344f4fe74f4546" data-category="link" href="Principles_of_pain_management#Zd673a3f7ee36023aab5a267899e984cc" data-lxid="xN0EWg">pain</a>)</li> <li>
<a data-tip="q8WCnM0" id="L7af041db69f3d8c544cbfca83814e02b" data-category="link" href="OB/GYN:_history_and_physical_examination#Z6172909bf6c18e4379fe5eda2b6149c6" data-lxid="1r02Th">Pelvic exam</a> including <a data-tip="3rbSSE" id="Lbe7c1c706ba783390e74a84fadc7b8e2" data-category="link" href="Diagnostic_procedures_in_gynecology#Z03d851016803f84c54f90d0ed1f404de" data-lxid="SN0y0g">speculum examination</a>
</li> </ul>
</li> <li>Imaging is not required as part of routine screening but should be requested if disease recurrence is suspected. [4]</li> <li>Address underlying <a data-tip="b31HSg0" id="Lf794721ce12cf2599c48ffa9c5da7848" data-category="link" href="Interpreting_medical_evidence#Zbc0d0ff153bc5c7a27589815d0c842fd" data-lxid="ps0LDh">risk factors</a> (see “<a id="L3b1116d7b5b318bb56639309c0a8e75c" data-category="link" href="Endometrial_cancer#Z8a800189234036294bfcc081f70518e8" data-lxid="0O0eIT">Prevention of endometrial cancer</a>”) and provide <a id="Lc76340ab508540b1ff5444e49ca0358a" data-category="link" href="Principles_of_cancer_care#Zdc46151b60c73e17f737986b89e4564e" data-lxid="TH06ph">postcancer treatment care</a>. [4]</li> </ul>
A <a data-tip="pfaLMP" id="L6d2c6271c40955dee5f18902570b985d" data-category="link" href="Cervical_cancer_screening#Za2fc6744be13cc07ce5af3bcf24cf0b4" data-lxid="880Oo3">Pap smear</a> should not be used to assess for <a data-tip="vjXAXy" id="Lc9164ef52440d6a1e6f4a0faad67ba14" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancer recurrence, as it has not been shown to improve the detection of local recurrence and may yield <a data-tip="QlXu9y" id="Le56b8b8cd1c37591544511f5a32bf623" data-category="link" href="Interpreting_medical_evidence#Z550845838cb304b466906d18ba06dbea" data-lxid="ps0LDh">false-positive</a> results. [27]

Follow up

<ul class="condensed-hidden">
<li>
Pyometra [28] <ul>
<li>An accumulation of <a data-tip="vIYAeq" id="L90c894e465c05f33ecb09652569072c0" data-category="link" href="Skin_and_soft_tissue_infections#Zfdfb82d83e675513c49619bc646fd20c" data-lxid="qh0CUf">pus</a> in the <a id="L5a0a505ec727f6975c9eecf702e8b583" data-category="link" href="Female_reproductive_organs#Zb95110a56e7421b27948a60b18c44b23" data-lxid="O60IOS">uterine cavity</a>
</li> <li>Caused by infection resulting from obstruction of the cervical opening by the <a id="L8ae3636dce0e2f3bb1b1ca1fc36aae15" data-category="link" href="General_oncology#Z333a818dbf71a509f924e54006a41fb6" data-lxid="WM0Png">tumor</a> and secondary blood stasis (<a data-tip="wQ0hyf" id="Lb0b4905bfbf8f272904275f89082dd56" data-category="link" href="Anomalies_of_the_female_genital_tract#Z769e35cdcec46d1b91b14c0e8a8897e4" data-lxid="vk0ApT">hematometra</a>)</li> <li>Can develop in patients with duplication of the <a data-tip="NsX-Ez" id="L95751998481b2938006f24d746cb74d8" data-category="link" href="Female_reproductive_organs#Zcbc35556e6d59e81460e41d87b9a0849" data-lxid="O60IOS">cervix</a> or as an uncommon complication of gynecological <a data-tip="OHXIqz" id="L5ec43e72630e720a27f0066204df32e4" data-category="link" href="General_oncology#Z8c3bce39ca977e0f872b6d9fb3be8cfb" data-lxid="WM0Png">malignancy</a>
</li> <li>Presented with <a data-tip="vIYAeq" id="L20db7948372bd8cce9ebfb323773151f" data-category="link" href="Skin_and_soft_tissue_infections#Zfdfb82d83e675513c49619bc646fd20c" data-lxid="qh0CUf">purulent</a> <a id="L10f8add931afebfec0605c6695b16c29" data-category="link" href="Diagnostic_procedures_in_gynecology#Zb662926dc2d34490a899d22f644e85f3" data-lxid="SN0y0g">vaginal discharge</a>, lower abdominal <a id="Le16c4f63c4bfbc577efb589b562cac05" data-category="link" href="Principles_of_pain_management#Zd673a3f7ee36023aab5a267899e984cc" data-lxid="xN0EWg">pain</a>, and enlarged <a id="Le33ad6f4ed1be5a4b75ee0704de58735" data-category="link" href="Female_reproductive_organs#Za01eee7dd508a9ffebff19996b63507a" data-lxid="O60IOS">uterus</a>
</li> <li>Diagnosed by imaging studies (e.g., abdominal <a data-tip="fK0kfS" href="Ultrasound#Z4254d71ea91bb85a18eeeaaf5e7adbef" data-category="link" id="L832cb06b78d9edda464a7a0ccc58d450" data-lxid="4n03tg">ultrasound</a> or <a data-tip="Fn0gEg" href="Computed_tomography#Ze2b9f34cdbf89aef620d4cba111183d1" data-category="link" id="L4ade741599b3510cd6fb7ff5a2a30ddd" data-lxid="KN0UXg">CT scan</a>)</li> <li>Treated with drainage and dilation of the cervical lumen</li> </ul>
</li> </ul>
We list the most important complications. The selection is not exhaustive.

Complications

<ul class="condensed-hidden">
<li>
<a data-tip="vjXAXy" id="L610738cd0e9705fa42eaa3ba7bbf1284" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">Endometrial</a> cancer has the 2nd best prognosis (after <a data-tip="lM0vKg" href="Invasive_cervical_cancer#Zb0043b20d16c82430e1686560be81736" data-category="link" id="L29f9757bbe8417335a11c05bdde914da" data-lxid="ZO0ZIT">cervical cancer</a>) of all gynecological cancers in the US. [5]</li> <li>
<a data-tip="frXkgz" id="L49c0b6d2c120d20ae9cc1c0f3e6e5f94" data-category="link" href="General_oncology#Z3ca9eb235037578e2df50f335eb50537" data-lxid="WM0Png">Cancer stage</a> at diagnosis determines the 5-year survival rate: [5] <ul>
<li>Localized <a data-tip="vjXAXy" id="Lbed806f1b79eb66254df21a1c7553a78" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> <a data-tip="58XiM-" id="L702dc567aa9dd68fb32c3f9f0751a0fd" data-category="link" href="General_oncology#Z22674f156f136302ff6142f806db0d5a" data-lxid="WM0Png">carcinoma</a>: > 90 % <span class="api explanation" data-category="bonus" data-content="QXBwcm94aW1hdGVseSB0d28tdGhpcmRzIG9mIGNhc2VzIGFyZSBkaWFnbm9zZWQgYXQgYSBsb2NhbGl6ZWQgc3RhZ2UuCg==" id="Ef2c36b2f3d7531beb1ffb48c238875fd" data-tip=" "> </li> <li>
<a data-tip="IrXYiz" id="L3cf5dcfdbed3ac163d08029b8b223d4c" data-category="link" href="General_oncology#Z56ce78424b29da57669d773285a33fa6" data-lxid="WM0Png">Metastasized</a> <a data-tip="vjXAXy" id="Le10157989762359e5e0e9727216c44ef" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> cancer: < 20 % </li> </ul>
</li> <li class="additional">
<a href="Death#Z50d4cd4f1799c2c9f72dcc5af8b9aace" data-category="link" id="L72b977905a15848f45dda22156989309" data-lxid="vP0AgT">Death</a> rate: ∼ 5 per 100,000 women per year [5]</li> <li>Types of <a data-tip="vjXAXy" id="Lfeee4e326469680312e8005e31742e75" data-category="link" href="Female_reproductive_organs#Z35fc608984a172f7b06b0a5f7fb12522" data-lxid="O60IOS">endometrial</a> <a data-tip="58XiM-" id="L9443bf7196212a4c2ee1a8c2d23b1afa" data-category="link" href="General_oncology#Z22674f156f136302ff6142f806db0d5a" data-lxid="WM0Png">carcinomas</a> that are well-differentiated and possess <a data-tip="OTbIIG" id="L0f6986a814873191ecc1ed9bc61ba3c4" data-category="link" href="Female_sex_hormones#Z9f773b700d306dca5a1f7c25325b2ece" data-lxid="uk0ppT">estrogen</a> <a id="Lbe9b399eee8e151b53aff60cfdea63da" data-category="link" href="Signal_transduction#Z3ff0122a3c004eebed96e9db47e16ea4" data-lxid="qo0C1S">receptors</a> (type I) have a more favorable prognosis.</li> <li>
<a data-tip="kUXmWx" id="L72cab83997ac1c14efd6d0bda7956b89" data-category="link" href="Renal_cell_carcinoma#Z309ac58bcb2057f29f10ad161593de32" data-lxid="Ki0Usf">Clear cell</a> and <a data-phrasegroup-id="pR0LLf" data-category="bonus" class="api dictionary" data-content="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" id="L1732336e0e2b348bf3159a9a0d353b55" data-source="L1732336e0e2b348bf3159a9a0d353b55" data-tip="pR0LLf">papillary</a> serous <a data-tip="58XiM-" id="Ldc6706a594982d6bba45f40b6b628c01" data-category="link" href="General_oncology#Z22674f156f136302ff6142f806db0d5a" data-lxid="WM0Png">carcinomas</a> (type II) have an aggressive course and a poor prognosis.</li> </ul>

Prognosis

<ul>
<li>
Routine <a data-tip="Y9bnND" id="Lce725fd2ecaadb364c8a170364625b69" data-category="link" href="Preventive_medicine#Zd2fd362c44ad4ff1b5182e47fa326067" data-lxid="Wj0Pzf">screening tests</a> are not available. [4][6]
</li> <li class="condensed-hidden">Screen for and address <a data-tip="b31HSg0" id="L1f867c10a09161789a90f7c5980f329b" data-category="link" href="Interpreting_medical_evidence#Zbc0d0ff153bc5c7a27589815d0c842fd" data-lxid="ps0LDh">risk factors</a>: <ul>
<li>Offer <a id="Lcd761bf4775c231798d12b28678e924d" data-category="link" href="Obesity_and_metabolic_syndrome#Z613f18d9a5d5dd57818334552eaba116" data-lxid="4g03v2">obesity management</a>.</li> <li>Avoid prescribing unopposed <a data-tip="OTbIIG" id="Lef09a7ee8c1f31bc04a12e45befd4351" data-category="link" href="Female_sex_hormones#Z9f773b700d306dca5a1f7c25325b2ece" data-lxid="uk0ppT">estrogen</a>.</li> <li>Optimize management of associated conditions, e.g., <a data-tip="a40Q3T" href="Diabetes_mellitus#Z1235e572dd827cff7d31e954b3f94489" data-category="link" id="L8d4cee721bd7b72f2111a1226d67d3bd" data-lxid="3g0SE2">diabetes</a>, <a data-tip="Pk0WLT" href="Hypertension#Zce0d4554dd0bc7f9fba742d2827ffc63" data-category="link" id="Lb541c1a63ace7c1bc9b8eb5fb5c138d7" data-lxid="Xh09cf">hypertension</a>
</li> <li>Educate patients on <a data-tip="sFWtjM0" id="La88bc0cbf43a16f7ebc069d0994a8b8e" data-category="link" href="Tobacco_product_use_and_smoking_cessation#Zf73b2202ff32a1191c49f9795b38374a" data-lxid="mr0V3h">smoking cessation</a>. <span class="api explanation" data-category="bonus" data-content="U21va2luZyBpbmNyZWFzZXMgdGhlIHJpc2sgb2YgPGEgaHJlZj0iRW5kb21ldHJpYWxfY2FuY2VyI1o3YTFiNGQyNWM5OTBiM2RjOTBkZjZkZDA3Yzk4ZmQ0MCIgZGF0YS1jYXRlZ29yeT0ibGluayIgaWQ9IkxjMTBiZGEyZDc4Nzc0YmNiODVjZGM4Mjg4Mzk1OTYzZCIgZGF0YS1zZWN0aW9uLWlkPSI3NGM0a2MwIiBkYXRhLWx4aWQ9IjBPMGVJVCI+dHlwZSBJSSBlbmRvbWV0cmlhbCBjYW5jZXI8L2E+Lgo=" id="E1b0a30b17cea526ea1f647a059d9bedb" data-tip=" "> [4]
</li> </ul>
</li> <li class="condensed-hidden">Educate the following patients on recognizing the <a id="La133b49bc8b46a97839de2431b06df3d" data-category="link" href="Endometrial_cancer#Z388b30fec42f53c2c9070d0325f38fd9" data-lxid="0O0eIT">symptoms of endometrial cancer</a>: [29] <ul>
<li>All <a data-tip="XSa9yP" id="L14c482f60f858c1f741bbd2efa552305" data-category="link" href="Menopause#Z028440e5b47771796d4ba443d65fad68" data-lxid="BO0zuT">postmenopausal</a> patients</li> <li>
<a data-tip="cSaaAP" id="L57ebaa19cf988b83ad4770e09a3de413" data-category="link" href="Menopause#Z2288200fd1105ba221b2adb4a5080961" data-lxid="BO0zuT">Premenopausal</a> patients with <a data-tip="b31HSg0" id="Lb18ba2dfb7339388326e0866ed23b74c" data-category="link" href="Interpreting_medical_evidence#Zbc0d0ff153bc5c7a27589815d0c842fd" data-lxid="ps0LDh">risk factors</a> such as <a data-tip="H40KkT" href="Lynch_syndrome#Z223291f8ddc1791ddb38550c25b8a05c" data-category="link" id="La572bfdc90eba3d63493dbbb50f08006" data-lxid="fS0k_2">Lynch syndrome</a>, <a data-tip="3faSNP" id="L858bd319525454a87b2c9778377b001e" data-category="link" href="Female_sex_hormones#Z62c2028efe014cd4faaf82ccb312cd4c" data-lxid="uk0ppT">tamoxifen</a> use, <a data-tip="Xn097g" href="Polycystic_ovary_syndrome#Zbd81e7bf0ad319fff0a5830a22d12550" data-category="link" id="Laf37b9c2f783b0ac66d5654697013ed1" data-lxid="AO0RET">PCOS</a>, <a data-tip="Rs0luh" id="L51da200c49720383e1b41cbaa7b72e5e" data-category="link" href="Obesity_and_metabolic_syndrome#Z6f8e50436ee2db7b982c290b29f9ddbc" data-lxid="4g03v2">obesity</a>
</li> </ul>
</li> <li class="additional condensed-hidden">Patients with <a data-tip="H40KkT" href="Lynch_syndrome#Z223291f8ddc1791ddb38550c25b8a05c" data-category="link" id="L6aef96e7388b031ae67a37443be23772" data-lxid="fS0k_2">Lynch syndrome</a> who wish to preserve their <a id="L560c899277fb0d553d4d954ae5800ca4" data-category="link" href="Female_reproductive_organs#Za01eee7dd508a9ffebff19996b63507a" data-lxid="O60IOS">uterus</a> should undergo yearly <a data-tip="0XYe9n" id="L7b6463a4d7cf61a3a9ee8c8821d2957e" data-category="link" href="Diagnostic_procedures_in_gynecology#Z8d28dacdc3d7d2e1afe4a9fa445ef6b7" data-lxid="SN0y0g">TVUS</a> with <a data-tip="xSaEb4" id="L2fb5a1d2fdd84ff88a8abe8b10ba17cd" data-category="link" href="Pneumonia#Z351264651d762713a247d997f6eae551" data-lxid="mh0Vef">aspiration</a> <a data-phrasegroup-id="sebtZG" data-category="bonus" class="api dictionary" data-content="PHA+VGhlIHJlbW92YWwgb2YgY2VsbHMgb3IgdGlzc3VlIGZvciBsYWJvcmF0b3J5IGV4YW1pbmF0aW9uIG9yIHRlc3RpbmcuIFNldmVyYWwgbWV0aG9kcyBleGlzdCB0byByZW1vdmUgdGhlIHRhcmdldCB0aXNzdWUgKGUuZy4sIGZpbmUgbmVlZGxlIGFzcGlyYXRpb24sIHB1bmNoIGJpb3BzeSkuPC9wPg==" id="L478728f5b75b34fde51efebba60b6b34" data-source="L478728f5b75b34fde51efebba60b6b34" data-tip="sebtZG">biopsy</a> from age 35 years. [26]
</li> </ul>

Prevention

National Cancer Institute Cancer Stat Facts: Uterine Cancer

Diagnosis and management of endometrial cancer

Type I and II Endometrial Cancers: Have They Different Risk Factors?

Soya food intake and risk of endometrial cancer among Chinese women in Shanghai: population based case-control study

ACOG Practice Bulletin No. 149 Endometrial Cancer

The North American Menopause Society Recommendations for Clinical Care of Midlife Women

ACR Appropriateness Criteria® Pretreatment Evaluation and Follow-Up of Endometrial Cancer

Committee Opinion No. 557 (reaffirmed 2020): Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women

Endometrial cancer: A review and current management strategies: Part I

ACOG Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Women With Postmenopausal Bleeding

Endometrial Cancer

Abnormal Uterine Bleeding in Premenopausal Women

Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors

Committee Opinion No. 631: Endometrial Intraepithelial Neoplasia

Committee Opinion No. 631 Endometrial intraepithelial neoplasia

Endometrial Carcinoma

Current recommendations and recent progress in endometrial cancer

A comparison of various endometrial cancer management guidelines

Endometrial cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Mismatch Repair Universal Screening of Endometrial Cancers (MUSE) in a Canadian Cohort

Cancer of the corpus uteri: 2021 update

Pyometra: a potentially lethal differential diagnosis in older women

American Cancer Society Guidelines for the Early Detection of Cancer: Update of Early Detection Guidelines for Prostate, Colorectal, and Endometrial Cancers