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Endometrial hyperplasia and cancer

Gynaecological oncology

The commonest gynaecological cancer and the one that announces itself: postmenopausal bleeding is investigated every time.

Foundations

Endometrioid adenocarcinoma, FIGO grade III, invading slightly more than half the myometrium.
Endometrial carcinoma: the relationship between the tumour and the cervix decides the stage.
  • Risk is unopposed oestrogen: obesity, anovulation and PCOS, nulliparity, late menopause, tamoxifen, oestrogen-only therapy with a uterus; and Lynch syndrome (screen for it in those diagnosed under 60 or with a family history).
  • Postmenopausal bleeding: transvaginal ultrasound; an endometrium of 4 mm or less makes cancer unlikely, otherwise endometrial biopsy (or hysteroscopy if the biopsy is inadequate or bleeding persists).
  • Hyperplasia without atypia: progestin (the levonorgestrel IUD) and surveillance; with atypia (endometrial intraepithelial neoplasia): hysterectomy, or high-dose progestin with close follow-up if fertility is wanted.
  • Cancer: mostly endometrioid, found early (stage I) with a good prognosis; staged surgically (hysterectomy, bilateral salpingo-oophorectomy, sentinel nodes); molecular classification (POLE, mismatch repair, p53) now guides adjuvant treatment. Serous and clear-cell types behave aggressively.

On the modelEndometriumBody and myometriumFundus and cornua

Frameworks and sources

  • FIGO: The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes (PALM-COEIN), 2018 revisions (2018).

Content reviewed 2026-09. Teaching material for students, not clinical decision support; check the current edition of the guideline your unit uses.