Endometrial Cancer

Abstract

Most common gynecological cancer in the U.S; fourth most common malignancy in women after breast, lung, and colorectal. Risk factors: unopposed estrogen, postmenopausal (median age at diagnosis is 61 years), nulliparity, early menarche, late menopause, obesity, tamoxifen (7.5×), oral contraceptives use. Grade is determined by percentage of dedifferentiated solid growth pattern: Grade 1: ≤5%, Grade 2: 5–50%, Grade 3: >50%. Seventy-five percent of tumors are endometrioid endometrial adenocarcinomas, which are estrogen-dependent tumors that commonly present with postmenopausal bleeding and are ­frequently preceded by endometrial hyperplasia. Rate of progression to invasive cancer from simple hyperplasia is rare (<2%) with progression to carcinoma in patients with simple and complex hyperplasia with atypia being more ­common (30–40%). Twenty percent of endometrial carcinomas are nonendometrioid including papillary serous (UPSC), clear cell, and mucinous. Papillary serous and clear cell carcinomas are often diagnosed with more advanced disease and have a poorer prognosis. Up to 5% of uterine cancers are sarcomas, including carcinosarcoma (most common), leiomyosarcoma, and endometrial stromal sarcomas. Prognostic factors = stage (#1), cell type, grade, LVSI, depth of invasion, cervical extension, and patient age. Primary lymphatic drainage is to pelvic LN (internal and external iliac, obturator, common iliac, presacral, parametrial); direct spread may occur to paraaortic LN. ∼1/3 of patients with + pelvic LN have + paraaortic LN.