Endometrial Cancer

Excerpt

Uterine corpus cancer is the most prevalent gynecologic malignancy in the United States. In 2023 alone, over 66,000 new cases were expected, and over 13,000 deaths were due to this cancer. Endometrial carcinomas accounted for a significant number of these cases, as fewer than 10% of uterine corpus cancers are sarcomas; this type of carcinoma comprises more than 83% of the uterine corpus cancers reported. More virulent serous and papillary serous carcinomas make up 4% to 6% of endometrial carcinomas, and 1% to 2% are clear cell carcinomas.

Endometrial cancer is a malignancy originating within the epithelial lining of the uterus. The condition has historically been classified into type 1 and type 2 endometrial cancer based on histological characteristics. However, results from recent studies have begun classifying endometrial cancers according to a current molecular subgrouping system. Type 1 cancers are more common, with 80% of all endometrial cancers of endometrioid origin. Type 2 endometrial cancers are primarily of serous or clear cell origin. The most significant risk factors associated with endometrial cancer development include those that increase long-term exposure to unopposed estrogen (eg, obesity and exogenous estrogen). Differentiating type 1 endometrioid from type 2 serous endometrial carcinomas and other highly aggressive nonendometrioid carcinoma histotypes is essential to understanding, managing, and possibly preventing these diseases.

Common symptoms include abnormal uterine bleeding, pelvic pain, and uterine enlargement. Initial evaluation of endometrial cancer consists of a transvaginal ultrasound followed by an endometrial biopsy to confirm the diagnosis. However, an endometrial biopsy may also be performed as the initial study. Additional imaging studies may be conducted to evaluate patients for metastases. Management is based on surgical staging with total hysterectomy with bilateral salpingo-oophorectomy, lymphadenectomy, and peritoneal washings. In patients with cancer confined to the endometrium and myometrium, further treatment is typically unnecessary. However, in patients with advanced disease, a therapeutic approach comprised of surgical therapy in addition to radiotherapy, hormone therapy, or chemotherapy is often utilized. The prognosis is usually favorable in cancers diagnosed at an early stage.