Snapshot A 58-year-old woman presents to her gynecologist for vaginal bleeding. She denies any vaginal pain or trauma and is not on any medications. Medical history is notable for morbid obesity and denies undergoing menopause. A transvaginal ultrasound is performed, which demonstrates endometrial thickening of 6 mm. She underdgoes an endometrial biopsy, which is consistent with endometrial cancer. Introduction Overview malignancy affecting the endometrium of the uterus Epidemiology incidence most commonly affects women > 40 years of age risk factors elevated estrogen exposure unopposed estrogen use polycystic ovarian syndrome early menarche estrogen producing tumor obesity nulliparity or history of infertility longterm tamoxifen use Lynch syndrome family history Pathophysiology estrogen acts on estrogen receptors in the endometrium, promoting endometrial proliferation and increasing the risk of cancer development normally, progesterone inhibits proliferation of the endometrium abnormalities in progesterone lead to unopposed endometrial proliferation Associated conditions cervical adenocarcinoma primary or ovarian cancer Prognosis prognostic factors improved Presentation Symptoms abnormal uterine bleeding postmenopause any bleeding 45 to menopause frequent, heavy, or prolonged bleeding < 45 years of age persistent bleeding concerning in patients with risk factors (e.g., chronic anovulation and obesity) Imaging Transvaginal ultrasound indication initial imaging study for the evaluation of abnormal uterine bleeding in postmenopausal women determines endometrial thickness Hysteroscopy indication performed with dilation and curettage (D&C) in cases where transvaginal ultrasound and endometrial biopsy is unremarkable Studies Invasive studies endometrial biopsy indication a method of confirming the diagnosis via histology Differential Uterine leiomyoma differentiating factors enlarged smooth muscle tumor Adenomyosis differentiating factors endometrial gland and stroma in the myometrium Treatment Treatment depends whether the tumor is confined to the uterus or has metastasized treatment involves surgery with or without chemotherapy, hormonal therapy, and radiation Medical progestine therapy indication endometrial cancer confined to the uterus in women who want to preserve fertility Surgical total hysterectomy and bilateral salpingo-oophorectomy indication initial management for endometrial cancer along with pelvic and para-aortic lymphadenectomy also collecting peritoneal fluid for cytology Complications Anemia Metastasis