Endometrial Cancer

INTRODUCTION

Endometrial cancer is the most common malignancy of the female reproductive system, arising from the lining of the uterus (endometrium). It mainly affects postmenopausal women and is often detected early due to abnormal uterine bleeding, which improves prognosis.

DEFINITION

Endometrial cancer is a malignant tumor that develops from the endometrial lining of the uterus, usually due to prolonged exposure to estrogen without the balancing effect of progesterone.

CAUSES (Etiology)

• The exact cause is not always known, but the major underlying mechanism is unopposed estrogen stimulation of the endometrium.

Key causes include:

• Hormonal imbalance (excess estrogen, low progesterone)

• Endometrial hyperplasia (precancerous condition)

• Genetic mutations (e.g., Lynch syndrome)

• Obesity (fat tissue converts androgens into estrogen)

• Chronic anovulation (e.g., PCOS)

  
  

RISK FACTORS

• Factors that increase the likelihood of developing endometrial cancer:

• Postmenopausal age

• Obesity (strongest risk factor)

• Nulliparity (no childbirth)

• Early menarche & late menopause

• Unopposed estrogen therapy

• Polycystic ovarian syndrome (PCOS)

• Diabetes mellitus & hypertension

• Family history of cancer (especially colon cancer)

• Use of tamoxifen

  
  

CLINICAL MANIFESTATIONS

Symptoms often appear early:

Common signs and symptoms:

• Abnormal uterine bleeding (most important sign)

• Postmenopausal bleeding (red flag symptom)

• Intermenstrual bleeding

• Watery or blood-tinged vaginal discharge

• Pelvic pain or pressure (late stage)

• Weight loss and fatigue (advanced disease)

  
  

DIAGNOSIS

• Early diagnosis is key for better outcomes.

Investigations include:

• Endometrial biopsy → Gold standard (confirmatory test)

• Transvaginal ultrasound (TVS) → measures endometrial thickness

• Hysteroscopy → direct visualization of uterine cavity

• Dilation and curettage (D&C) → tissue sampling

• CT/MRI scan → staging and spread assessment

• Pap smear → not diagnostic but may detect abnormal cells.

MEDICAL MANAGEMENT

• Used in early cases, advanced disease, or when surgery is not suitable:

1. Hormonal Therapy

Progestins (main drug) to counteract estrogen effect

2. Radiotherapy

External beam radiation

Brachytherapy (internal radiation)

3. Chemotherapy

Used in advanced or metastatic cancer

4. Targeted/Immunotherapy

Used in selected advanced cases

SURGICAL MANAGEMENT

• Primary and most effective treatment:

• Total hysterectomy (removal of uterus)

• Bilateral salpingo-oophorectomy (BSO) (removal of ovaries & fallopian tubes)

• Pelvic and para-aortic lymph node dissection

• Debulking surgery (in advanced cancer)

  
  

NURSING MANAGEMENT

Nursing care focuses on physical, emotional, and educational support:

1. Assessment

Monitor vaginal bleeding

Assess pain and general condition

Observe for anemia and weakness

2. Preoperative Care

Explain surgical procedure

Provide psychological support

Ensure consent and preparation

3. Postoperative Care

Monitor vital signs and bleeding

Pain management

Prevent complications (infection, DVT)

Encourage early ambulation

4. Patient Education

Importance of follow-up care

Medication adherence

Lifestyle changes (weight control, diet, exercise)

5. Emotional Support

Address fear, anxiety, and body image issues

Support coping with cancer diagnosis.

---

🚀Here’s a short “exam trick” version for Endometrial cancer — super quick points you can remember :

Introduction

Most common cancer of the female reproductive tract affecting uterine lining.

Definition

Malignant growth of endometrial (uterine lining) cells.

Causes

• Excess estrogen without progesterone.

• Hormonal imbalance.

• Genetic factors (e.g., Lynch syndrome).

• Obesity-related estrogen increase.

Risk Factors

• Postmenopausal age.

• Obesity.

• Nulliparity.

• Early menarche / late menopause.

• Diabetes, hypertension.

• Estrogen therapy without progesterone.

Clinical Manifestations

• Abnormal uterine bleeding (most common).

• Postmenopausal bleeding.

• Pelvic pain.

• Vaginal discharge.

• Weight loss (late stage).

Diagnosis

• Endometrial biopsy (confirmatory).

• Transvaginal ultrasound.

• Hysteroscopy.

• Dilation and curettage (D&C).

Medical Management

• Hormonal therapy (progestins).

• Chemotherapy in advanced cases.

• Radiation therapy

.

Surgical Management

• Total hysterectomy (main treatment).

• Bilateral salpingo-oophorectomy.

• Lymph node removal (staging).

Nursing Management

• Monitor vaginal bleeding.

• Pain management.

• Pre/post-operative care.

• Emotional support.

• Educate on follow-up and lifestyle changes.

---

🚀Here’s a set of 07 MCQs on Endometrial for practice :

1. Endometrial cancer commonly arises from:

A. Cervix

B. Ovary

C. Endometrium

D. Fallopian tube

✅ Answer: C

2. Most common presenting symptom is:

A. Fever

B. Abnormal uterine bleeding

C. Headache

D. Vomiting

✅ Answer: B

3. Major risk factor for endometrial cancer:

A. Low BMI

B. Obesity

C. Early menopause

D. Multiparity

✅ Answer: B

4. Gold standard for diagnosis:

A. CT scan

B. MRI

C. Endometrial biopsy

D. Pap smear

✅ Answer: C

5. Primary treatment of endometrial cancer:

A. Chemotherapy

B. Radiotherapy

C. Surgery (hysterectomy)

D. Antibiotics

✅ Answer: C

6. Which hormone is mainly responsible for causing endometrial cancer?

A. Progesterone

B. Estrogen

C. Insulin

D. Thyroxine

✅ Answer: B

7. Endometrial cancer is most common in:

A. Adolescents

B. Reproductive age women

C. Postmenopausal women

D. Children

✅ Answer: C