Endometrial Cancer

Abstract

The epidemiology, prevention, diagnosis, treatment, prognosis, and new International Federation of Gynecology and Obstetrics staging system of endometrial carcinoma are reviewed. Endometrial cancer has increased 21% in incidence since 2008, and the death rate has increased more than 100% over the past two decades. Precursor lesions of complex hyperplasia with atypia are associated with an endometrial carcinoma in more than 40% of cases. Endometrial cancer in white women occurs at twice the incidence as in black women, but, stage for stage, black women have a less favorable prognosis. Preoperative imaging cannot accurately assess lymph node involvement. Gross examination of depth of myometrial invasion does not have the sensitivity, specificity, positive predictive value, or negative predictive value to select women who can have lymphadenectomy safely omitted from the surgical procedure. Although surgical staging remains the most accurate method of determining the extent of disease, the therapeutic value of pelvic lymphadenectomy has not been established. The anatomical extent of lymphadenectomy and the number of lymph nodes removed to establish prognostic and therapeutic benefit are controversial. Research efforts are directed at identifying women with early stage endometrial cancer who only require total hysterectomy and bilateral salpingo-oophorectomy. Minimally invasive surgical techniques have become established as standard therapy for treating women with endometrial cancer. Women with a family history of hereditary nonpolyposis colorectal cancer are at increased risk for endometrial cancer. Conservative treatment to allow for childbearing is possible in select situations. Women with endometrial cancer should be managed by physicians experienced in the complex multimodality treatment of this disease.

Does robotic surgical staging of endometrial cancer compromise outcomes?

“…The RALH cohort also had fewer positive para-aortic lymph nodes, which is in accord with the lower percentage of positive pelvic nodes in this group. While it is certainly possible that some in the RALH were under-staged, particularly with respect to the para-aortic node dissection, this does not appear to have an impact on the risk of recurrence [17].…”

“…Thus, despite the theoretical risk of increased manipulation of the uterus during robotic hysterectomy and the difficulty of performing para-aortic node dissections with the robotic approach, we did not find any impact on recurrence risk. Although the survival value of lymphadenectomy is controversial, it is prognostic and useful in selecting appropriate adjuvant therapy [17].…”

Use of nonsteroidal anti-inflammatory drugs and risk of endometrial cancer: a nationwide case–control study

“…Of 5,751 eligible endometrial cancer cases, we restricted the analysis to include only the 5,382 cases with endometrial cancer classified as type I or II (please see morphology codes in Supplementary Table 1). Type I cancer is of endometrioid morphology and far more common than type II tumors, which comprise a heterogeneous and poorly differentiated group [1].…”

“…Endometrial cancer is the sixth most common cancer in women worldwide, and the incidence is rising [1]. Development of the disease is suggested to be strongly associated with estrogen (endogenous or exogenous), which unopposed by progesterone induces mitotic activity in endometrial cells with subsequent increased risk of malignant transformation [2,3].…”

Benign ve malign endometriyal patolojilerin klinik ve demografik özelliklerinin karşılaştırılması

“…5mm eşik değer olarak alındığında negatif prediktif değer %99 iken, 4mm alındığında %100 olmaktadır. Karsinomların %96'sında kalınlık 5mmnin üzerinde tespit edilmiştir [10][11][12][13]. Yapılan çalışmalarda postmenopozal kanamalı ve histopatolojik tanısı endometriyum kanseri olarak saptanan kadınlarda ise ortalama endometriyal kalınlık 13,9-21,1 mm tespit edilmiştir [14].…”