NCLEX Review Guide: Endometrial (Uterine) Cancer

Understanding Endometrial Cancer

• Endometrial cancer is the most common gynecologic malignancy, arising from the endometrial lining of the uterus. The majority (80-85%) are adenocarcinomas that develop from glandular tissue.
• Two main types exist: Type I (estrogen-dependent, well-differentiated) accounts for 80% of cases, while Type II (non-estrogen dependent, poorly differentiated) is more aggressive with poorer prognosis.

Signs and Symptoms

• Abnormal uterine bleeding is the hallmark symptom, occurring in 90% of cases - particularly postmenopausal bleeding which should always be investigated.
• Premenopausal women may experience heavy menstrual periods, intermenstrual bleeding, or prolonged bleeding episodes.
• Advanced disease may present with pelvic pain, abdominal distension, weight loss, and palpable pelvic mass.

Diagnostic Workup

1. Endometrial biopsy - gold standard for diagnosis, can be performed in office setting
2. Transvaginal ultrasound to assess endometrial thickness (>4mm in postmenopausal women warrants further evaluation)
3. Dilation and curettage (D&C) if biopsy inadequate or high suspicion remains
4. CT or MRI for staging once diagnosis confirmed
5. Chest X-ray and laboratory studies (CBC, comprehensive metabolic panel, CA-125 if indicated)

Surgical Treatment

• Total hysterectomy with bilateral salpingo-oophorectomy is the primary treatment for most endometrial cancers, often performed via minimally invasive techniques.
• Lymph node dissection may be performed based on tumor grade, depth of invasion, and other high-risk features.
• Fertility-sparing options (progestin therapy) may be considered for young women with early-stage, well-differentiated tumors who desire future pregnancy.

Adjuvant Therapy

• Radiation therapy (external beam or brachytherapy) for intermediate to high-risk disease or positive surgical margins.
• Chemotherapy typically reserved for advanced or recurrent disease, commonly using carboplatin and paclitaxel combination.
• Hormone therapy with progestins for hormone receptor-positive recurrent disease.

Preoperative Nursing Care

• Assess baseline vital signs, pain level, and psychosocial status including anxiety about cancer diagnosis and surgical outcomes.
• Provide preoperative education about procedure, expected outcomes, and postoperative care including early ambulation and respiratory exercises.
• Ensure informed consent is obtained and address patient questions or concerns about fertility, sexuality, and body image changes.

Postoperative Nursing Care

1. Monitor for surgical complications: bleeding, infection, thromboembolism, and bowel/bladder dysfunction
2. Assess incision sites for signs of infection, dehiscence, or hematoma formation
3. Encourage early ambulation and deep breathing exercises to prevent complications
4. Monitor urinary output and bladder function, especially after extensive pelvic surgery
5. Provide pain management using multimodal approach including non-pharmacologic interventions

Quick Knowledge Check

• ☐ I can identify the primary risk factors for endometrial cancer
• ☐ I understand why postmenopausal bleeding requires immediate evaluation
• ☐ I can explain the difference between Type I and Type II endometrial cancers
• ☐ I know the gold standard diagnostic procedure for endometrial cancer
• ☐ I can describe appropriate postoperative nursing care priorities
• ☐ I understand the importance of long-term follow-up care