Carcinoma of the Endometrium **1. Definition and Overview:  Carcinoma of the endometrium, also known as endometrial cancer, originates in the lining of the uterus (the endometrium). It is one of the most common gynecological cancers and primarily affects postmenopausal women, although it can occur in premenopausal women as well. **2. Etiology and Risk Factors:  Hormonal Factors: Estrogen exposure plays a significant role in the development of endometrial cancer. Conditions that lead to prolonged estrogen exposure without adequate progesterone, such as unopposed estrogen therapy or polycystic ovary syndrome (PCOS), increase the risk.  Age: The risk of endometrial cancer increases with age, most commonly occurring in women between 55 and 65 years old.  Obesity: Excessive body fat is associated with higher estrogen levels, which can increase the risk of endometrial cancer.  Reproductive History: Factors such as nulliparity (having no children) or infertility can elevate risk. Additionally, women with early menarche or late menopause are at increased risk due to prolonged estrogen exposure.  Genetic Predisposition: Genetic syndromes such as Lynch syndrome (hereditary non-polyposis colorectal cancer) can significantly increase the risk of endometrial cancer. **3. Clinical Presentation:  Abnormal Uterine Bleeding: The most common symptom of endometrial cancer is abnormal uterine bleeding, including postmenopausal bleeding or heavy, irregular menstrual periods in premenopausal women.  Pelvic Pain: Some women may experience pelvic pain or discomfort.  Vaginal Discharge: A watery or bloody vaginal discharge can occur in some cases. **4. Diagnosis:  Endometrial Biopsy: An endometrial biopsy is the primary diagnostic tool, where a sample of the endometrial tissue is examined microscopically for cancer cells.  Transvaginal Ultrasound: This imaging technique helps assess the thickness of the endometrium. Abnormal thickening can indicate potential cancer, prompting further investigation.  Hysteroscopy: A procedure where a thin, lighted tube (hysteroscope) is inserted through the vagina and cervix to view the inside of the uterus and obtain tissue samples if needed.  D&C (Dilation and Curettage): In some cases, a D&C may be performed to remove and analyze tissue from the endometrium for diagnosis. **5. Treatment:  Surgery: The primary treatment for endometrial cancer is surgical. A total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) is performed to remove the uterus, cervix, ovaries, and fallopian tubes.  Radiotherapy: Radiation therapy may be used postoperatively to target any remaining cancer cells or as a primary treatment in certain cases.  Chemotherapy: Chemotherapy is used for more advanced or recurrent cases of endometrial cancer.  Hormonal Therapy: In some cases, hormonal treatments like progestins may be used, particularly in patients who are not candidates for surgery or in the management of early-stage disease. **6. Prognosis and Follow-Up:  Prognosis: The prognosis for endometrial cancer depends on the stage at diagnosis, grade of the tumor, and overall health of the patient. Earlystage cancers generally have a good prognosis with appropriate treatment.  Follow-Up: Regular follow-up is important to monitor for recurrence and manage any treatment-related side effects. Follow-up typically includes physical examinations, imaging studies, and possibly additional biopsies.