Endometrial Cancer

Abstract

The uterus is the most common site of cancer in the female genital tract. Most uterine cancers in the United States arise from the endometrium, which is the innermost layer of the uterine corpus and constitutes the lining of the uterine cavity. The endometrium is an integral component of the female reproductive system, undergoing cyclic changes in response to intricate variations in circulating levels of sex hormones, which ultimately result in the development of a local environment optimal for the implantation and subsequent development of an embryo. Shifting trends with an apparent increase in incidence of endometrial cancer across the world probably reflect changes in the prevalence of established risk factors, namely obesity, low parity, late menarche, early menopause, and increasing age. Most patients present at an older age than patients with cervical cancer. The typical clinical scenario is vaginal bleeding in a postmenopausal female. Prognosis depends on a number of factors: the most important is the depth of myometrial invasion by tumor, but other factors include stage, lymphovascular invasion, histologic grade, and lymph node status. If detected at an early stage, endometrial cancer is potentially curable. Diagnosis is made on the basis of clinical suspicion with pathological confirmation from transvaginal biopsy or curettage of the endometrial cavity. Imaging has little role in the diagnosis of the primary tumor, but it is helpful for staging newly diagnosed cancer and detecting recurrence following endometrial cancer treatment.