Endometrial Carcinoma

Clinical Case:

A 56 year-old G0 presents to the clinic with complaints of intermittent vaginal bleeding. She went through the menopause 2 years ago and had no vaginal bleeding until 6 months ago when she had a three day episode of light bleeding. Since that time, she has had another 3 such episodes. Past medical history is remarkable for well-controlled hypertension, depression and “borderline” diabetes for which the patient is on a diet to which she is minimally adherent. She never used contraceptives but was unable to become pregnant. She has had a laparoscopic cholecystectomy. She takes Lisinopril and Zoloft. Her family history is non-contributory. On examination, she has normal vital signs, she weighs 247 pounds. Her heart, lungs and abdominal exams are normal. On pelvic examination, she has normal external genitalia, normal vagina and cervix. The bimanual exam is difficult secondary to the patient's habitus, but the uterus feels slightly enlarged and no adnexal masses are palpable.

Discussion questions:

  1. What is your differential diagnosis for this patient?
  2. What is the etiology of endometrial cancer?
  3. What risk factors does this patient have for endometrial cancer?
  4. What factors are protective against endometrial cancer?
  5. What are the next steps in the diagnostic work-up of this patient?
  6. You obtain an ultrasound which shows a 10 cm uterus and no adnexal masses. Endometrial biopsy reveals complex hyperplasia with atypia. Are further diagnostic tests indicated?
  7. How would you treat the patient?


  1. Obstetrics and Gynecology by Beckmann 5 th Edition, 2006; Chapter 46 Endometrial Hyperplasia and Cancer. Pages 455-463.
  2. Essentials of Obstetrics and Gynecology by Hacker and Moore 4 th Edition, 2004; Chapter 42 Uterine Corpus Cancer. Pages 478-485.

Endometrial cancer is the most common malignancy.

The APGO Educational Objectives related to this topic are the following:

  1. List the risk factors for endometrial carcinoma *
  2. Describe the symptoms and physical findings of a patient with endometrial cancer*
  3. Outline the appropriate management of the patient with postmenopausal bleeding *
  4. Discuss the use of the diagnostic methods for a patient with endometrial carcinoma

*Designated as Priority One in the APGO Medical Student Educational Objectives, 8 th Edition

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