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 login to view 4 more bullets 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 login to view 1 more bullet Associated conditions cervical adenocarcinoma primary or ovarian cancer Prognosis prognostic factors improved Presentation Symptoms abnormal uterine bleeding postmenopause login to view 1 more bullet 45 to menopause login to view 1 more bullet < 45 years of age login to view 2 more bullets Imaging Transvaginal ultrasound indication initial imaging study for the evaluation of abnormal uterine bleeding in postmenopausal women login to view 1 more bullet 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 login to view 1 more bullet 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 login to view 1 more bullet Surgical total hysterectomy and bilateral salpingo-oophorectomy indication login to view 3 more bullets Complications Anemia Metastasis