Endometrial Cancer

Endometrial cancer is the most common gynecologic malignancy in the USA; it is the fourth most common malignancy in women after breast, colorectal, and lung cancer. About 36,000 new cases of endometrial cancer occur per year. Peak incidence occurs in women aged 50 to 60, and the incidence appears to be increasing. Risk factors include obesity, nulliparity, and prolonged use of unopposed exogenous estrogen.

The most common symptom is postmenopausal vaginal bleeding. Diagnosis requires endometrial biopsy, although it is sometimes suggested by Pap smear. Early diagnosis and treatment have made the prognosis for endometrial cancer better than that for other gynecologic malignancies. However, prognosis is influenced by the stage of the tumor (see Table 118-2); 5-year survival rates range from 75 to 90% for those with stage I disease to 10% for those with stage IV disease. The combined 5-year survival rate for all stages is about 65%. Older women have a poorer prognosis.

Optimal treatment is hysterectomy, bilateral oophorectomy, and retroperitoneal lymph node dissection in the pelvic and para-aortic areas. Upper vaginal or pelvic radiation therapy, chemotherapy, or both may be required for advanced cancer based on stage, the patient's comorbidities, and the results of a thorough discussion of risks and benefits.