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Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). It mainly occurs after menopause, and presents with vaginal bleeding. A hysterectomy (surgical removal of the uterus) is generally performed. It is the most common gynecologic cancer in the United States, with over 35,000 women being diagnosed each year in the U.S. Because of effective screening, it is only the third most common cause of gynecologic cancer deaths (behind ovarian and cervical cancer). The same risk factors for endometrial cancer predisposes women to endometrial hyperplasia, which is a precursor lesion for endometrial cancer. An atypical complex hyperplasia carries a 30% risk of developing endometrial cancer while a typical simple hyperplasia only carries a 2-3% risk. Endometrial cancer is often referred to as uterine cancer, however the uterus may harbor other malignacies, including cervical cancer, sarcoma, and trophoblastic disease.
Epidemiology Endometrial cancer occurs in both premenopausal (25%) and postmenopausal women (75%). The most commonly affected age group is between 50 and 59 years of age. Most tumors are caught early and thus prognosis is good and morbidity is declining. Risk Factors Most women with endometrial cancer have a history of unopposed and increased levels of estrogen. One of estrogen's normal functions is to stimulate the buildup of the endometrial lining of the uterus. Excess estrogen administered to laboratory animals can produce endometrial hyperplasia, which is a precursor for cancer. Increased estrogen may be due to: The incidence of endometrial cancer in women in the U.S. is 1 % to 2 %. The incidence peaks between the ages of 60 and 70 years, but 2 % to 5 % of cases may occur before the age of 40 years. Increased risk of developing endometrial cancer has been noted in women with increased levels of natural estrogen. Associated conditions include the following: Increased risk is also associated with the following: Women who have a history of endometrial polyps or other benign growths of the uterine lining, postmenopausal women who use estrogen-replacement therapy (specifically if not given in conjunction with periodic progestin) and those with diabetes are also at increased risk. Tamoxifen, a drug used to treat breast cancer, can also increase the risk of developing endometrial cancer. Symptoms Diagnosis Results from a pelvic examination are frequently normal, especially in the early stages of disease. Changes in the size, shape or consistency of the uterus and/or its surrounding, supporting structures may exist when the disease is more advanced. Pathology Histopathology is usually an endometrioid adenocarcinoma. It appears on a background of endometrial hyperplasia. Tumor cells are atypical and form irregular glands, with multiple lumens, pluristratification. The stroma is reduced, producing the "back to back" aspect. With evolution of the disease, the myometrium is infiltrated. Evaluation Patients with newly-diagnosed endometrial cancer do not routinely undergo imaging studies, such as CT scans to evaluate for extent of disease, since this is of low yield. Preoperative evaluation should include a complete medical history and physical examination, pelvic examination and rectal examination with stool guaiac test, chest X-ray, complete blood count, and blood chemistry tests, including liver function tests. Colonoscopy is recommended if the stool is guaiac positive or the woman has symptoms, due to the etiologic factors common to both endometrial cancer and colon cancer. The tumor marker CA-125 is sometimes checked, since this can predict advanced stage disease. Stages of endometrial cancer Endometrial carcinoma is surgically staged using the FIGO cancer staging system. Treatment The primary treatment is surgical. Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy). Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed. Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation therapy. Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease. Support Groups The stress of illness can often be helped by joining a support group where members share common experiences and problems. Expectations Because endometrial cancer is usually diagnosed in the early stages (70 % to 75 % of cases are in stage 1 at diagnosis; 10 % to 15 % of cases are in stage 2; 10 % to 15 % of cases are in stage 3 or 4), there is a better probable outcome associated with it than with other types of gynecological cancers such as cervical or ovarian cancer. Survival rates The 5-year survival rate for endometrial cancer following appropriate treatment is: Complications | |||||||||||||||||||||||||||
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