Endometrial cancer is the most common gynecologic malignancy in the United States. Approximately 39,080 new cases will be diagnosed in 2007. Most (approximately 90%) of these tumors are adenocarcinomas arising from the lining of the uterus. Risk factors for endometrial cancer include white race, obesity, early menarche and late menopause, nulliparity, tamoxifen therapy, estrogen replacement therapy, infertility, hereditary nonpolyposis colon cancer (HNPCC), and factors leading to unopposed estrogen exposure. Pregnancy and oral contraceptive use appear to be protective. Complex atypical endometrial hyperplasia, a precursor lesion, progresses to carcinoma in 29% of cases if left untreated. Only 1% to 3% of cases of hyperplasia without atypia progress to carcinoma. Hyperplasia can be treated conservatively with progestins and close observation with follow-up endometrial biopsy. Extrafascial hysterectomy is suggested for persistent hyperplasia in patients who have completed their childbearing.
Presentation and clinical features of Endometrial cancer.
The most common symptom is abnormal vaginal bleeding, often in a postmenopausal patient. Approximately three fourths of patients present with stage I disease. Endometrial sampling should be considered mandatory in all postmenopausal women. Although Endometrial cancer is rare in women younger than 35 years, patients in this age group who have persistent noncyclic vaginal bleeding, are nonresponsive to medical management, or are morbidly obese should undergo endometrial assessment (ACOG Practice Bulletin 65. In: Compendium of Selected Publications. Washington, DC: American College of Obstetrics and Gynecology; 2007:1128).
Physical of Endometrial cancer examination should include
an assessment for obesity, hirsutism, and other signs of hyperestrogenism. The uterus may be enlarged or of normal size.
Diagnosis of Endometrial cancer is by transcervical aspiration
(e.g., Pipelle), which usually is performed as an office procedure, or by hysteroscopy/D & C, which is performed in the operating room. Ultrasound can help to suggest an intrauterine abnormality.