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Endometrial Cancer for NP

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Endometrial Cancer for the Nurse Practitioner Licensing Exam
Definition and Epidemiology
  • Definition
    • Endometrial cancer is a malignancy of the endometrium, the lining of the uterus, and is the most common gynecologic cancer in the United States.
    • Main types:
    • Type I (Endometrioid): Estrogen-dependent, often linked with endometrial hyperplasia.
Endometrioid Cancer Pathophysiology
    • Type II (Non-endometrioid): Estrogen-independent, includes more aggressive types like serous and clear cell carcinoma.
  • Epidemiology
    • Primarily affects postmenopausal women, with peak incidence between ages 55-65.
    • Increasing incidence, associated with obesity-related estrogen exposure.
Risk Factors
  • Hormonal Factors:
    • Unopposed Estrogen: High estrogen without progesterone promotes endometrial proliferation.
    • Obesity: Increases peripheral estrogen production.
    • Polycystic Ovarian Syndrome (PCOS): Chronic anovulation leads to continuous estrogen exposure.
  • Genetic Factors:
    • Lynch Syndrome: Increases endometrial cancer risk.
    • Cowden Syndrome: Mutation in PTEN gene associated with multiple cancers.
  • Other Factors:
    • Early menarche, late menopause, nulliparity, and tamoxifen use.
Clinical Manifestations
  • Abnormal Uterine Bleeding (AUB):
    • Most common symptom, especially postmenopausal bleeding.
    • In premenopausal women, may present as irregular or heavy bleeding.
  • Pelvic Pain:
    • Typically seen in advanced disease due to local tumor spread.
Diagnosis
  • Transvaginal Ultrasound (TVUS):
    • Initial imaging; endometrial thickness >4 mm in postmenopausal women warrants biopsy.
  • Endometrial Biopsy:
    • Gold standard for diagnosis, indicated for postmenopausal bleeding or high-risk premenopausal women with AUB.
  • Hysteroscopy:
    • Used for direct visualization and biopsy of focal lesions if needed.
Treatment
  • Surgical Management:
    • Total Hysterectomy with Bilateral Salpingo-Oophorectomy (THBSO) is standard.
  • Adjuvant Therapy:
    • Radiation for high-risk disease; chemotherapy for advanced or aggressive cases.
Key Points
  • Endometrial Cancer is the most common gynecologic malignancy, often presenting with postmenopausal bleeding.
  • Risk Factors include unopposed estrogen, obesity, PCOS, Lynch syndrome, and tamoxifen.
  • Diagnosis relies on transvaginal ultrasound and endometrial biopsy.
  • Treatment: THBSO is standard, with adjuvant radiation or chemotherapy for advanced stages.

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