Endometrial cancer

Endometrial cancer is classically seen in post-menopausal women but around 25% of cases occur before the menopause. It usually carries a good prognosis due to early detection

The risk factors for endometrial cancer are as follows*:

• obesity
• nulliparity
• early menarche
• late menopause
• unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
• diabetes mellitus
• tamoxifen
• polycystic ovarian syndrome

Features

• post-menopausal bleeding is the classic symptom
• pre-menopausal women may have a change intermenstrual bleeding
• pain and discharge are unusual features

Investigation

• first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
• hysteroscopy with endometrial biopsy

Management

• localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy. Patients with high-risk disease may have post-operative radiotherapy
• progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery

*the oral contraceptive pill is protective