Endometrial Cancer is a malignancy of the lining of the uterus. The term uterine cancer is also used but this also includes malignancies that arise in other areas of the uterus. It is the 4th most common cancer in women and the most commonly diagnosed cancer of the female genital tract in developed countries. In developing countries it is 2nd to cervical cancer. It has a 96% 5 year survival rate when detected early and prompt treatment is given.
The risk of endometrial cancer is approximately 3% in all women but increases with age. The risk is approximately 6% in women age 35-44 and 19% in those ages 45-54. The risk peaks at about 33% in women age 54-64, then drops after this. Most endometrial cancers develop as a result of excessive exposure to estrogen. There are many external and internal factors, which contribute to this increased exposure.
The high survival rate is primarily due to its early presentation. Abnormal uterine bleeding is the first sign of endometrial cancer and typically occurs in 75-90% of all cases. Abnormal cytology on pap smear or an incidental finding after a hysterectomy tends to be the presentation the rest of the time.
Abnormal uterine bleeding has many presentations and can have numerous causes. Bleeding in a postmenopausal woman is most certainly abnormal and should be evaluated immediately. Other signs of abnormalities include prolonged periods, excessive bleeding, irregular or intermenstrual bleeding and bleeding after intercourse. Evaluation under these circumstances is indicated.
Other problems can cause abnormal bleeding, thus the assessment should include testing to evaluate all probable causes. A complete history and physical examination, a pregnancy test in reproductive age women, complete blood count and imaging of the pelvis are the most commonly used tests. An endometrial sampling is the definitive way to determine if a malignancy is present. This can either be done by pipelle sampling done in the office or a dilatation and curettage done under anesthesia in an operating room.
In postmenopausal women an ultrasound to measure the thickness of the endometrial lining can be very helping in determining the need for sampling. This is a useful tool because an office sampling may not be feasible due to the changes that occur in the reproductive tract after menopause.
Women who develop abnormal uterine bleeding should seek the care of a gynecologist promptly. Women who are postmenopausal and have any bleeding should seek the care of a gynecologist immediately. Even though the idea is frightening, an early diagnosis is the key to survival in women with endometrial cancer.
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