Chapter 31: Endometrial Cancer

LEARNING OBJECTIVES

1. Evaluate the risk factors for endometrial cancer.

2. Explain when an evaluation for endometrial cancer would be necessary based upon signs and symptoms.

3. Define the standard of care for treating endometrial cancer based upon current guidelines and disease status.

4. Describe the short- and long-term complications associated with the treatment of endometrial cancer.

INTRODUCTION

Uterine cancers, also known as uterine neoplasms, are cancers of the uterus and encompass both malignant epithelial tumors of the endometrium (endometrial cancer) and uterine sarcomas. Endometrial cancer is the most common genital tract malignancy in women in developed countries and the second most common genital tract malignancy in women after cervical cancer in developing countries. Prognosis and treatment for endometrial cancer is dependent upon histologic subtype. The most common histologic subtype diagnosed is pure endometrioid endometrial carcinoma that tends to have a better prognosis than other subtypes. Endometrioid cancers commonly present with abnormal uterine bleeding and are typically diagnosed at an earlier stage while other subtypes of uterine cancer may or may not present with abnormal uterine bleeding and are associated with a worse prognosis. This chapter will focus on the most common subtype, endometrioid endometrial carcinoma.

Epidemiology

The highest incidence rates for endometrial cancer are in North America and Europe. Rates are lower in southern and eastern Asia and most of Africa.¹ In the United States, endometrial cancer is the 4th most common cancer diagnosis in women and 6th most common cause for cancer-related death for women.² The likelihood of developing endometrial cancer for a woman during her lifetime is 1 in 35.² It is estimated 63,230 new uterine cancer cases will be diagnosed in 2018, with 11,350 women dying of the disease.² Cancer survival has improved for all of the most common cancers in the United States except for cancer of the uterus and cervix.² The death rate for uterine cancers rose by about 2% from 2011 to 2015.² These increases are in part attributed to increasing lifespan, as endometrial cancer is most commonly diagnosed among women aged 55 to 64 with a median age of diagnosis at age 62, and also to increasing rates of obesity, which is a significant risk factor for endometrial cancer.^3,4

Endometrial cancer is typically diagnosed at an early stage due to symptomatic presentation even at early stages. Based on the 2007-2013 Surveillance Epidemiology and End Results (SEER) data on endometrial cancer, the majority of patients, 67%, were diagnosed with disease confined to the uterus, 21% had regional disease, and 9% had distant disease.² The 5-year relative survival rates for uterine cancer without regard to subtype correspond to stage at diagnosis with survival rates of 95%, 69%, and 16% for localized, regional, and distant.² Overall 5-year survival for all stages is 81%.²

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