Endometrial Cancer
Endometrial cancer usually presents with abnormal uterine bleeding, especially postmenopausal bleeding; prompt referral, histological diagnosis, MMR and molecular assessment, and risk-adapted gynaecological oncology treatment are the key steps.
Definition
Endometrial cancer is a malignant tumour arising from the uterine lining, most commonly an endometrioid carcinoma but also including serous, clear-cell, carcinosarcoma and other histological types. Prognosis and treatment are determined by symptoms and examination, histological type and grade, stage, lymphovascular invasion and molecular classification.
First principles
Abnormal bleeding is the safety-net symptom
Postmenopausal bleeding, unscheduled bleeding on HRT, persistent intermenstrual or heavy bleeding and, less commonly, watery discharge can be presenting symptoms. Most postmenopausal bleeding is not cancer, but it requires a structured assessment because bleeding often occurs while disease is still potentially curable. Persistent or recurrent bleeding needs re-investigation even after a reassuring initial result.
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