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Most endometrial cancers are adenocarcinomas that typically are well differentiated and hormone sensitive. In these patients, estrogen stimulation is unopposed and the endometrium proliferates and becomes thickened. The endometrial cells undergo changes in structure and cellular morphology. Endometrial hyperplasia results in the development of atypical endometrial cells and in the subsequent development of type I endometrial cancer. Risk factors for adenocarcinoma of the endometrium are long-term anovulation without management (such as with polycystic ovary syndrome [PCOS]); obesity; estrogen-secreting tumors; early menarche; late menopause; (as mentioned) unopposed estrogen; the use of tamoxifen; and a history of breast, ovarian, or colon cancer.
The main symptom of endometrial cancer is painless and abnormal bleeding. This would include excessive bleeding during times of menstruation, as well as inter-menstrual bleeding. Increased and prolonged menstrual flow is common in these patients, and any bleeding in postmenopausal women warrants a significant workup. Post-coital bleeding, pelvic pain, and cramping, in addition to enlarged lymph nodes, are signs of more advanced disease. If endometrial cancer is diagnosed early, it is treatable and curable (