Endometrial cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Endometrial cancer refers to several types of malignancy which arise from the endometrium, or lining of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year in the U.S. The most common subtype, endometrioid adenocarcinoma, typically occurs within a few decades of menopause, is associated with excessive estrogen exposure, often develops in the setting of endometrial hyperplasia, and presents most often with vaginal bleeding. Because symptoms usually bring the disease to medical attention early in its course, endometrial cancer is only the third most common cause of gynecologic cancer death (behind ovarian and cervical cancer). A hysterectomy (surgical removal of the uterus) is the most common therapeutic approach.
Endometrial cancer may sometimes be referred to as uterine cancer. However, different cancers may develop from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease.
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 USG, 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, uterine cancer is the fourth most common type of cancer among women.[1] In the United States, the age-adjusted prevalence of uterine cancer is 231.9 per 100,000 in 2011.[2] In 2011, the age-adjusted incidence of uterine cancer was 27.05 per 100,000 persons in the United States.[2]
Risk Factors
Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen, obesity, diabetes, high blood pressure and genetic disorders.
Natural History, Complications and Prognosis
If left untreated, 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
The staging of endometrial cancer is based on the FIGO staging system.
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 the initial imaging modality used in the detection of suspected pulmonary metastasis. It normally 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 cancerdepends on the stage at diagnosis.
Surgery
The feasibility of surgery depends on the stage of endometrial cancer at diagnosis.
References
- ↑ Uterine cancer statistics. CDC.gov
- ↑ 2.0 2.1 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.