Uterus (womb) is a hollow, inverted pear-shaped organ that accommodates the growing fetus during pregnancy. It is situated between the urinary bladder and rectum in the pelvic cavity and it is held in position by several uterine ligaments.
It is made-up of mainly 3 tissue layers: the outermost, perimetrium (an extension of peritoneum that is composed of areolar connective tissue and forms few uterine ligaments and covers several organs in the pelvis); the middle layer, myometrium (composed of smooth muscle fibers that produce powerful coordinating contractions to expel the fetus during labor); and the innermost, endometrium (which is the site for endometrial cancer and is further divided into basal and functional layer). The functional layer is transient which develops and shed in cycles in response to mainly two hormones estrogen and progesterone until the menopause (cessation of menstrual cycles in women). The basal layer is permanent and gives rise to a new functional layer after each menstrual cycle.
Endometrioid adenocarcinomas are the most commonly encountered (about 95% of all cases) endometrial cancer. Other less common but aggressive subtypes of endometrial adenocarcinoma include clear-cell carcinoma, mucinous adenocarcinoma, and papillary serous adenocarcinoma.
Most endometrial cancers develop from precancerous lesions known as endometrial hyperplasia (an abnormally increased growth of endometrium). Endometrial hyperplasia is divided into four subtypes: simple hyperplasia, complex hyperplasia, simple atypical hyperplasia, and complex atypical hyperplasia. The risk of developing endometrial cancer is highest (about 29%) in complex atypical hyperplasia. All the pre-cancerous lesions are generally treated to avoid a development into invasive disease.
Endometrial Cancer Infographics
FIGO (International Federation of Gynecological Oncologists) Staging is the staging system used for endometrial cancer. It helps in disease prognostication and deciding an appropriate treatment strategy. It is explained in the images below.
Localised and Locally Advanced Disease
As seen above, stage I to stage IVA disease is either limited to the endometrium or invaded locoregionally, but has not spread to distant sites. The infographic below discusses the treatment for localised and locally advanced endometrial cancer.
When there is spread of the disease to distant sites, it classifies under stage stage IVB and treatment is as discussed below.