What is the stage of endometrial carcinoma when it involves the cervix?

Stage 2: Cancer has spread to the cervix.

Stage 1: Cancer confined to the uterus.

Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis.

Stage 4: Cancer has spread to distant sites.

Endometrial Cancer for FMGE: High-Yield Obstetrics and Gynecology Lessons

Endometrial Cancer: Epi & Risks - Cancer's Guest List

Most common GYN malignancy (developed nations); 4th common cancer in women.
Peak: 55-65 yrs (postmenopausal).
Key Risk: Unopposed Estrogen
- Exogenous: Estrogen Replacement Therapy (ERT) without progestin.
- Endogenous:
  - Obesity (↑ peripheral estrone).
  - Nulliparity.
  - Early menarche (<12 yrs).
  - Late menopause (>52 yrs).
  - PCOS (chronic anovulation).
  - Estrogen-secreting tumors.
Other Major Risks:
- Tamoxifen (endometrial agonist).
- Diabetes Mellitus, Hypertension.
- Lynch Syndrome (HNPCC).
- Family Hx (endometrial, ovarian, breast, colon).
- Prior pelvic radiation.

⭐ Lynch Syndrome (HNPCC) significantly ↑ endometrial cancer risk (40-60% lifetime), often preceding or co-occurring with colon cancer.

Endometrial Cancer Infographic

Protective: Combined Oral Contraceptives (COCs), progestins, multiparity, smoking (paradoxical).

Endometrial Cancer: Patho & Types - Tumor's ID Card

Precursor: Endometrial Hyperplasia (EH) → Atypical EH / Endometrial Intraepithelial Neoplasia (EIN) → Carcinoma.
- EH without atypia: Low malignant potential.
- Atypical EH / EIN: High risk (~30-50%) progression to carcinoma if untreated.

Endometrial hyperplasia vs carcinoma histopathology

Two Main Types: 📌 (Remember: Type I = Indolent/Estrogen; Type II = IIl/p53)

Feature	Type I (Estrogen-Dependent)	Type II (Estrogen-Independent)
Frequency	~80%	~10-20%
Histology	Endometrioid	Serous, Clear cell, Carcinosarcoma
Pathogenesis	Unopposed E2, EIN precursor	p53 mut, atrophy
Patient Profile	Perimenopausal, obese	Postmenopausal, thin
Key Mutations	PTEN, KRAS, MSI, ARID1A	TP53, PPP2R1A
Prognosis	Better	Poorer

- POLE ultramutated (Best prog, younger, immune "hot")
- MSI hypermutated (Good prog, Lynch, immune "hot")
- CN-low (Endometrioid, Intermediate prog)
- CN-high (Serous-like, TP53mut, Worst prog, immune "cold")

⭐ Lynch syndrome (HNPCC) significantly ↑ risk of endometrial cancer (MSI pathway), often the sentinel cancer.

Endometrial Cancer: Symptoms & Dx - Detective Work

Symptoms:
- Most Common: Abnormal Uterine Bleeding (AUB).
  - Postmenopausal Bleeding (PMB): Cancer until proven otherwise.
  - Premenopausal: Irregular, heavy, or intermenstrual bleeding.
- Less Common:
  - Serosanguinous/watery vaginal discharge.
  - Pelvic pain or pressure (advanced).
  - Pyometra (uterine pus).
Diagnosis:
- Initial: Transvaginal Sonography (TVS).
  - Measures Endometrial Thickness (ET).
  - PMB: ET > 4-5 mm suspicious, requires sampling.
  - Asymptomatic PM: ET > 11 mm may need investigation.
- Gold Standard: Endometrial Sampling.
  - Office endometrial biopsy (Pipelle).
  - Hysteroscopy + D&C if biopsy inconclusive or focal lesion.
- Staging: MRI pelvis, CT chest/abdomen.

Transvaginal Ultrasound Procedure

⭐ Any postmenopausal bleeding mandates investigation to rule out endometrial cancer.

Endometrial Cancer: Staging & Tx - Treatment Roadmap

FIGO 2023 Staging (Simplified)

Stage	Description
I	Confined to corpus uteri
IA	No or <50% myometrial invasion
IB	≥50% myometrial invasion
II	Cervical stromal invasion
	> ⭐ Stage II: Cervical stromal invasion is key.
III	Local/regional spread (serosa, adnexa, vagina, LN)
IIIC	Pelvic (IIIC1) or Para-aortic (IIIC2) LN mets
IV	Bladder/bowel mucosa (IVA) or distant mets (IVB)

Histologic Type (Endometrioid vs Non-endometrioid), Grade
Depth of myometrial invasion, LVSI
Lymph Node (LN) status, Molecular profile (POLE, MMRd, p53abn, NSMP)

Endometrial Cancer Molecular Classification

Simplified Treatment:

TAH+BSO: Total Hysterectomy + Bilateral Salpingo-oophorectomy; LND: Lymph Node Dissection; RT: Radiotherapy; VBT: Vaginal Brachytherapy; Rx: Therapy; EC: Endometrial Cancer.

High‑Yield Points - ⚡ Biggest Takeaways

Endometrial cancer is the most common gynecologic malignancy, mainly in postmenopausal women.

Unopposed estrogen (obesity, PCOS, tamoxifen) is the primary risk factor.

Postmenopausal bleeding is the hallmark symptom; requires TVUS and endometrial biopsy.

Type 1 (endometrioid): common (80%), estrogen-dependent, good prognosis.

Type 2 (serous/clear cell): aggressive, p53 mutation, poorer prognosis.

Strong association with Lynch syndrome (HNPCC).

FIGO staging is surgical; cornerstone of management.

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