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Chapter 093. Gynecologic Malignancies (Part 6)

Uterine Cancer Incidence and Epidemiology Carcinoma of the endometrium is the most common female pelvic malignancy. Approximately 39,080 new cases are diagnosed yearly, although in most (75%), tumor is confined to the uterine corpus at diagnosis, and therefore most can be cured. The 7400 deaths yearly make uterine cancer only the eighth leading cause of cancer death in females. | Chapter 093. Gynecologic Malignancies Part 6 Uterine Cancer Incidence and Epidemiology Carcinoma of the endometrium is the most common female pelvic malignancy. Approximately 39 080 new cases are diagnosed yearly although in most 75 tumor is confined to the uterine corpus at diagnosis and therefore most can be cured. The 7400 deaths yearly make uterine cancer only the eighth leading cause of cancer death in females. It is primarily a disease of postmenopausal women although 25 of cases occur in women ages 50 and 5 ages 40. The disease is common in Eastern Europe and the United States and uncommon in Asia. Proliferation of the endometrium is under the control of estrogen and prolonged exposure to unopposed estrogen from either endogenous or exogenous sources plays a central etiologic role. Risk factors for endometrial cancer include obesity low fertility index early menarche late menopause and chronic anovulation. Granulosa cell tumors of the ovary that secrete estrogen may present with synchronous endometrial cancers. Chronic unapposed estrogen replacement increases the risk and women taking tamoxifen for breast cancer treatment or prevention have a twofold increased risk. The Lynch syndrome occurs in families with an autosomal dominant mutation of mismatch repair genes MLH1 MSH2 MSH6 and PMS2 which predispose to nonpolyposis colon cancer as well as endometrial and ovarian cancer. The estimated lifetime risk for endometrial cancer is 40-60 with a mean age around 50 years. Unlike colorectal cancer endometrial cancer risk is not lower in MSH6 mutation carriers. Most women present with stage I disease and the survival rate is generally good 5-year survival 88 . No unique endometrial screening strategies have been established for Lynch family gene carriers. Clinical Presentation Endometrial carcinoma occurs most often in the sixth and seventh decades of life. Symptoms often include abnormal vaginal discharge 90 abnormal postmenopausal bleeding 80 and leukorrhea 10 . .