The natural history of endometrial adenocarcinoma is not well understood. Precursor lesions in the form of atypical hyperplasia are recognized but it is not known whether these changes always precede cancer development.

Endometrial adenocarcinoma exhibits a spectrum of differentiation from well-differentiated lesions with acinar or glandular morphology to poor differentiation with none. Lymph node metastases and prognosis are strongly associated with the degree of differentiation.

Adenosquamous lesions, clear cell, and serous papillary tumours all carry a worse prognosis. The other major prognostic factor is the depth of invasion of the myometrium and this is reflected in the FIGO staging classification.

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