Endometrial cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In the United States, endometrial cancer is the fourth most common type of cancer among women. Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. The pathophysiology of endometrial cancer depends on the 7 histological subtype: endometrioid, uterine papillary serous, mucinous, clear cell, squamous cell, mixed and undifferentiated. Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen, obesity, diabetes, high blood pressure and genetic disorders. The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer. Pelvic MRI and endometrial biopsy may be diagnostic of endometrial cancer. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The optimal therapy for endometrial cancer depends on the stage at diagnosis.
Classification
Endometrial cancer may be classified according to histology into 7 subtypes: endometrioid, uterine papillary serous, mucinous, clear cell, squamous cell, mixed, and undifferentiated.
Pathophysiology
Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. The pathophysiology of endometrial cancer depends on the histological subtype.
Differential Diagnosis
Endometrial cancer in early stage must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp, and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.
Epidemiology and Demographics
In the United States, endometrial cancer is the fourth most common type of cancer among women.[1] In the United States, the age-adjusted prevalence of endometrial cancer is 231.9 per 100,000 in 2011 and the age-adjusted incidence of endometrial cancer was 27.05 per 100,000 persons.[2]
Risk Factors
Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen use, obesity, diabetes, high blood pressure and genetic disorders.
Natural History, Complications and Prognosis
If left untreated, approximately 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. Common complications of endometrial cancer include vaginal bleeding and metastasis. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
Diagnosis
Staging
According to the FIGO Staging System, there are 4 stages of endometrial cancer.
History and Symptoms
The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer.
Chest Xray
Chest radiography (CXR) is may be helpful in diagnosis of pulmonary metastasis of endometrial cancer. The characteristic findings of pulmonary metastasis on chest radiography appears as peripheral, rounded nodules of variable size, scattered throughout both lungs.
CT
Pelvic postcontrast CT scan may be helpful in the diagnosis of endometrial cancer.
MRI
Pelvic MRI may be diagnostic of endometrial cancer.
Other Diagnostic Studies
Endometrial biopsy may be diagnostic of endometrial cancer.
Treatment
Medical therapy
The optimal therapy for endometrial cancer depends on the stage at diagnosis.
Surgery
The feasibility of surgery depends on the stage of endometrial cancer at diagnosis.
Primary Prevention
Effective measures for the primary prevention of endometrial cancer include a diet low in saturated fats and high in fruits and vegetables, physical activity and combination oral contraceptives.
Secondary Prevention
Secondary Prevention
References
- ↑ Uterine cancer statistics. CDC.gov
- ↑ Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.