Medicine, made legible under exam pressure.

Endometrial Cancer

**Endometrial cancer** is the most common gynaecological malignancy in developed countries and the sixth most common cancer in women. Around 90 per cent present with **postmenopausal bleeding**, which is cancer until proven otherwise. Two pathogenetic types exist: **Type I (endometrioid, 80 per cent)** is oestrogen-driven, arising through unopposed oestrogen stimulation, endometrial hyperplasia with atypia and well-differentiated carcinoma, with PTEN, PIK3CA, KRAS and ARID1A mutations and a favourable prognosis; **Type II (serous, clear cell, carcinosarcoma, 20 per cent)** is not oestrogen-driven, arises in atrophic endometrium, carries TP53 mutations, and is aggressive. Diagnosis is by **transvaginal ultrasound (endometrial thickness over 4 to 5 mm in a postmenopausal woman prompts biopsy), pipelle or hysteroscopy and dilation and curettage, and pelvic MRI for myometrial invasion and staging**. Treatment is **total hysterectomy, bilateral salpingo-oophorectomy, plus sentinel or full lymph node assessment**, with adjuvant vault brachytherapy for intermediate risk (PORTEC), external beam radiotherapy and chemotherapy (carboplatin and paclitaxel) for high-risk and advanced disease, and high-dose progestin for fertility-sparing management of grade 1 disease.