![]() Survival is generally defined by the stage of the disease and histology, with most patients at stage I and II having a favorable prognosis. Low- to medium-risk endometrial hyperplasia can be treated with nonsurgical options. Radiation and chemotherapy can also play a role in treatment. The mainstay of treatment for endometrial cancer is total hysterectomy with bilateral salpingo-oophorectomy. Most guidelines recommend either transvaginal ultrasonography or endometrial biopsy as the initial study. Evaluation of a patient with suspected disease should include a pregnancy test in women of childbearing age, complete blood count, and prothrombin time and partial thromboplastin time if bleeding is heavy. There is no evidence to support endometrial cancer screening in asymptomatic women. The American Cancer Society recommends that all women older than 65 years be informed of the risks and symptoms of endometrial cancer and advised to seek evaluation if symptoms occur. ![]() The most common presentation for endometrial cancer is postmenopausal bleeding. Additional risk factors are increasing age, obesity, hypertension, diabetes mellitus, and hereditary nonpolyposis colorectal cancer. Risk factors are related to excessive unopposed exposure of the endometrium to estrogen, including unopposed estrogen therapy, early menarche, late menopause, tamoxifen therapy, nulliparity, infertility or failure to ovulate, and polycystic ovary syndrome. It is the fourth most common cancer in women in the United States after breast, lung, and colorectal cancers. Endometrial cancer is the most common gynecologic malignancy.
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