Incidence
Endometrial carcinoma is the most common malignancy of the female genital tract in the USA. Among all malignancies in women, it is exceeded in frequency only by breast, lung, and colorectal cancer. The median age at the time of diagnosis is 62 years. A total of 40,100 new cases were estimated to be diagnosed in 2008. Only 7470 deaths from the disease occurred in 2008. The death rate for endometrial cancer is low because 85–90% are diagnosed early, while the tumor is still confined to the uterus. White women have higher incidence rates of endometrial carcinoma than black women, Asian women, American Indian women and Hispanic women, but black women have a much higher mortality rate from this disease than white women do. This is thought to be due to black women having a higher incidence of more aggressive histology types than white women, as well as less access to healthcare.
There appear to be two types of endometrial carcinoma: one which is estrogen related and one which is not. Factors associated with estrogen-related endometrial carcinoma include obesity, hypertension, diabetes mellitus, nulliparity, infertility, endogenous or exogenous estrogen, tamoxifen use and precursor lesions such as endometrial hyperplasia. Most estrogen-related endometrial carcinomas are diagnosed early and have a good prognosis, with an overall 5-year survival rate of 80%. Oral contraceptives, combined estrogen and progesterone postmenopausal hormone replacement therapy and cigarette smoking are protective factors.
Nonestrogen-related endometrial carcinoma tends to be seen more often in older, nonobese, parous women. These cancers tend to be more aggressive and are classified histologically as papillary serous and clear cell endometrial cancer. They have overall 5-year survival rates of 54% and 63% respectively.
There are also familial endometrial cancer syndromes such as Lynch II syndrome and hereditary nonpolyposis colorectal cancer syndrome.
The first sign of endometrial carcinoma is usually abnormal vaginal bleeding occurring after or around the time of the menopause. Any woman with abnormal perimenopausal or postmenopausal bleeding requires a careful evaluation for genital tract cancer.
Common presumptions regarding postmenopausal bleeding that can lead to a delay in diagnosis are that the bleeding is:
- due to supplemental estrogens in women receiving such therapy
- of vaginal origin in women with atrophic vaginitis
- from the endometrium, when it may be arising from cervical, vaginal or ovarian carcinoma
- not sufficient to require evaluation
Less commonly, the patient with endometrial carcinoma may present with enlargement of the uterus without bleeding or with chronic vaginal discharge (pyometra).
Prognostic factors and spread pattern
Prognosis and therefore survival are related to the histologic degree of differentiation, the extent of disease at the time of diagnosis, the quality of the therapy, and the patient’s medical status. Pretreatment evaluation is directed toward the definition of these factors.
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