Carcinoma endometrial: características clínicas, diagnóstico, prognóstico e rastreamento.

Abstract

Introduction: Uterine cancer is the most common gynecologic malignancy in high-income countries and the second most common in low- and middle-income countries (after cervical cancer). Endometrial adenocarcinoma is the most prevalent histopathologic subtype. Its cardinal symptom is abnormal uterine bleeding, and some patients may have normal findings on cervical cytology. Most are diagnosed when the disease is confined to the uterus, with a 90% 5-year survival rate. The main risk factor is excess endogenous or exogenous estrogen, without progestin opposition. Lynch syndrome (hereditary nonpolyposis colon cancer) is a genetic risk factor; the pathogenesis in these cases is germline mutation in DNA mismatch repair genes. Objective: to discuss endometrial carcinoma and its symptoms, diagnosis, prognosis, and screening. Methodology: Literature review of articles from the Scielo, PubMed and BVS databases, from January to March 2024, with the descriptors in English “endometrial carcinoma”, “clinical features”, “diagnosis” and “prognosis and screening”. Full articles from the last five years (2019-2024) were included, with a total of 30 studies. After reading, studies with other criteria were excluded, with 05 full articles chosen. Results and discussion: Abnormal uterine bleeding occurs in 75-90% of cases of endometrial carcinoma, mostly in patients over 55 years of age. Other presentations include abnormal cervical cytology findings, abnormal imaging findings or incidental findings when hysterectomy is performed for benign disease. Pelvic examination is usually normal in the early stage, as the uterus is not enlarged or tender as in more advanced cases. In postmenopausal women, the endometrium may be thickened on uterine imaging and, depending on the bleeding, the patient may already be anemic. The risk of cancer increases compared to benign disease as endometrial thickness approaches 20 mm on transvaginal ultrasound. Diagnosis of carcinoma is histopathological, with sampling by endometrial biopsy, curettage or hysterectomy. Prognosis is determined by tumor stage, grade and histology of the disease. Most patients have a favorable outcome due to endometrioid histology and early stage disease. Conclusion: For most patients, it is suggested not to perform screening tests (such as imaging, tissue sampling, cervical cytology) for endometrial carcinoma. All patients should be questioned and informed to report abnormal uterine bleeding. Early diagnosis aids in appropriate staging and management.