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Endometrial Carcinoma (Endometrial Hyperplasia's, Staging Of Ca Endometrium)

Feb 22, 2023

Endometrial Carcinoma

Endometrial carcinoma is the most common gynecologic malignancy and is responsible for a significant number of cancer-related deaths in women worldwide.

Early detection of endometrial carcinoma is crucial for effective treatment and improved outcomes. NEET PG exam tests a candidate's knowledge of the different diagnostic modalities and management options available for this condition.

Read this blog further for a quick overview of this important OBGYN topic for NEET PG exam preparation.

Important information

  • MC genital cancer of women in India: Ca Cervix
  • MC cancer of women in India: Ca Breast
  • MC tumor (benign/ malignant): fibroid uterus


Etiology: High estrogens

  • HRT: estradiol 1-2 mg/ day, CEE (conjugated equine estrogen 0.625- 1.25 mg/day). Must add progesterones to protect endometrium
  • Tamoxifen: SERM: Highly estrogenic on uterus, anti-estrogenic on breast, used in Ca breast
  • Early menarche and Late menopause: more menstrual cycles, more E exposure
  • Estrogen producing ovarian cancers → Granulosa cell tumor
  • Anovulatory conditions → PCOD: persistent high Estrogen
  • Obesity: Fats (1.5-2.5 times more likely)
  • Corpus cancer syndrome (Corpus= uterine body)
    • DM – HTN – Obesity
  • Abnormal liver function tests: altered estrogen metabolism
  • LYNCH II: HNPCC (Hereditary Non-Polyposis Colon Cancer): 40% association with Ca endometrium
  • Familial predisposition 
    • 1st degree female relatives can have either of these (even 2nd degree are predisposed)
      • Ca Breast
      • Ca Endometrium
      • Ca Ovary
  • Nulliparous woman: no break from Estrogen exposure. Each pregnancy gives around a 2 year break from menstruation. Thus it is not a common Indian cancer

Important Information

  • Excess estrogen: 80% of Ca endometrium: Type 1
  • No association with E excess: 20% of Ca Endometrium: Type 2

Previous year question

Question: A patient of carcinoma breast on tamoxifen is at a high risk of which of the following? (AIIMS 2020)

  1. Ovarian cancer
  2. Endometrial cancer
  3. Myeloid cancer
  4. Contralateral breast cancer


  • Hyperplasias: Cancer
  • Age group: 45-55 yrs


  • Simple Hyperplasia without atypia: 1%
  • Complex Hyperplasia without atypia: 3%

Give Progesterone Therapy

  • Simple Hyperplasia with atypia: 8%
  • Complex Hyperplasia with atypia: 29%

Do Simple Hysterectomy


  • Endometrioid adenocarcinoma [mc] [80%]
    • Papillary /villo glandular
    • Secretory
    • With Squamous differentiation  (mc)15-25%
  • Mucinous Ca
  • Serous Ca: Poor prognosis
  • Clear Cell Ca: poor prognosis


  • Co-existent obesity, DM, HTN
  • Irregular acyclical bleeding [mc]: Menometrorrhagia
  • Cyclical bleeding beyond age of menopause
  • Post menopausal bleeding
  • Pyometra: Dirty foul smelling vaginal discharge


  • 1st step: Local examination and Pipelle Endometrial Biopsy
    • On OPD basis, may use paracervical block
    • 90% sensitive
  • Fractional curettage [D & C]
    • Biopsy done from all walls, isthmus
    • 95-99% sensitive 
    • Done in OT
  • Hysteroscopic biopsy
    • 100% sensitive
    • Best 
  • Transvaginal sonography: 
    • Not best/ first
    • Good adjunctive investigation
    • ET should be ≤ 4mm is normal
    • 5mm or more should be investigated in menopausal women

Important Information

  • First step in diagnosis of Ca endometrium is not TVS. It is an office endometrial biopsy. Hysteroscopic biopsy is best.

Previous year question

Question: A 50 year old woman presents with abnormal uterine bleeding for 2 years. What shall be the next step in management?  (AIIMS 2020)

  1. Hysterectomy
  2. LNG-IUD
  3. Endometrial aspiration and cervical curettage
  4. Progesterone for 3 months

Staging Laparotomy

  • TAH + BSO: total abdominal hysterectomy + B/L salpingo-oophorectomy
  • Peritoneal cytology
  • LN assessment: if involved ? do a biopsy


2009 FIGO staging system for carcinoma of the endometrium

Stage I:  Tumor contained to the corpus uteri

  • IA: Less than half myometrial invasion
  • IB: Invasion equal to or more the half of the myometrium

Stage II: Cervical stromal involvement

Stage III: Local and/or regional spread of tumor

  • IIIA: Uterine serosa + positive peritoneal cytology
  • IIIB: Vaginal and/or parametrial involvement
  • IIIC: Metastases to pelvis and/or para-aortic lymph nodes
    • IIIC1 Positive pelvic nodes
    • IIIC2 Positive para-aortic lymph nodes 

Stage IV: Tumor invades bladder and/or bowel mucosa and/or distant metastases

  • IVA Tumor invasion of bladder and/or bowel mucosa
  • IVB Distant metastases, including intra-abdominal metastases and or inguinal lymph nodes
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Prognostic Factors

  • Staging: most significant
  • Grading : Differentiation of cancer: Solid areas on HPE slides
    • Grade I: <5% solid areas
    • Grade II: 5-50% solid areas 
    • Grade III: > 50% solid areas
C:\Users\admin\Downloads\Untitled-Artwork (15).png

Important information

  • Most significant prognostic marker: Staging > Grading
  • Age
  • Type: clear cell, serous type: poor prognosis
  • LN metastasis: most important
  • Estrogen & Progesterone receptors status: more the receptors, better prognosis
  • Myometrial invasion: bad prognosis
  • Previous Rx taken


  • Hysterectomy is already done
  • Stage I
    • Grade I, No Myometrial involvement: No more Rx required 
    • Grade I-II, Myometrium < 1/2 involved: Vaginal irradiation 
    • Grade III, Myometrium > ½ involved: Pelvic irradiation
  • Stage II
    • Adnexal or cervical involved: Whole abdominal irradiation
  • Stage III/ Stage IV
    • Individualized treatment 
    • Radiotherapy/ Chemotherapy/ Surgical / Hormonal therapy (Progesterone)
  • Vault of the vagina
    • Left over vagina after hysterectomy
    • MC site of recurrence
    • 1st line Mx of recurrence → High Progesterone [200-250 mg/day]

Important information

  • Most common cause of postmenopausal bleeding in India: Ca Cervix

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