Endometrial Cancer

1. See Also
   1. Endometrial Hyperplasia
   2. Dysfunctional Uterine Bleeding
   3. Cervical Cancer
2. Epidemiology
   1. Onset age over 50 years in 90% of cases (median age is 62 years)
   2. Most common gynecologic tract cancer
      1. Incidence 1.5 times more common than Ovarian Cancer
      2. Incidence 3 times more common than Cervical Cancer
   3. U.S. Statistics from 2011 (increasing Incidence, doubling in the last 20 years)
      1. Incidence: 46,470 new cases per year
      2. Mortality: 8120 deaths per year
      3. ACS Cancer facts and figures
         1. http://www.cancer.org/docroot/STT/stt_0.asp
3. Risk Factors
   1. See Endometrial Cancer Risk Factors (also includes protective factors)
   2. Hereditary nonpolyposis Colorectal Cancer (HNPCC) are at high risk of Endometrial Cancer
      1. Offer annual Endometrial Biopsy starting at age 35 years
   3. Paradoxically, Tobacco use is associated with a lower Incidence of Uterine Cancer
4. Types
   1. Type I - Endometrioid (75% of cases)
      1. Typically associated with Unopposed Estrogen with Endometrial Hyperplasia as a precursor
   2. Type II - Non-Endometrioid
      1. Not associated with Unopposed Estrogen with Endometrial Hyperplasia or other typical Endometrial Cancer Risks
      2. Includes serous, clear cell, mucinous, squamous, an adenosquamous types
      3. Onset at older age, more advanced stage and with worse prognosis
5. Pathophysiology
   1. See Endometrial Hyperplasia
6. Symptoms: Presentation (90% of cases)
   1. Abnormal Vaginal Bleeding
   2. Abnormal Vaginal Discharge
7. Evaluation
   1. See Endometrial Hyperplasia (for Endometrial Cancer Screening)
   2. See Dysfunctional Uterine Bleeding
8. Imaging: At time of Endometrial Cancer diagnosis
   1. Chest XRay
   2. Trasvaginal Ultrasound (if not already performed)
   3. Consider Pelvic MRI
9. Labs
   1. Pap Smear
   2. Cancer Antigen 125 (CA 125)
10. Staging
    1. See Endometrial Cancer Staging
11. Management
    1. Surgery
       1. Total Hysterectomy with bilateral salpingoophorectomy
          1. Tumor debulking in Stage IV Endometrial Cancer
       2. Peritoneal washings
       3. Para-aortic or pelvic lymph node dissection may be needed depending on staging
    2. Radiation Therapy
       1. May be indicated depending on tumor grade and Endometrial Cancer Staging
    3. Systemic therapy
       1. Progestins
       2. Tamoxifen
       3. Chemotherapy
          1. Doxorubicin (Adriamycin)
          2. Paclitaxel (Taxol)
12. Prognosis
    1. See Endometrial Cancer Staging
13. Prevention
    1. Manage Unopposed Estrogen states
14. References
    1. Buchanan (2009) Am Fam Physician 80(10): 1075-88
    2. Sorosky (2008) Obstet Gynecol 111(2 pt 1): 436-47