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

Aetiology

Risk factors

• excess oestrogen
  • 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
• metabolic syndrome
  • obesity
  • diabetes mellitus
  • polycystic ovarian syndrome
• tamoxifen
• hereditary non-polyposis colorectal carcinoma

Protective factors

• multiparity
• combined oral contraceptive pill
• smoking (the reasons for this are unclear)

Features

The classic symptom is

postmenopausal bleeding

• usually slight and intermittent initially before becoming heavier

Other features

• premenopausal women may develop menorrhagia or intermenstrual bleeding
• pain is not common and typically signifies extensive disease