Chapter 16 - Endometrial Cancer

Summary

Endometrial cancer is the most common gynecologic malignancy in the United States, and is rising in both incidence and associated mortality. In 2023 an estimated 66,000 new cases of uterine cancer will be diagnosed in the United States and over 400,000 women will be affected globally. Risk factors for the development of endometrial cancer include advancing age, obesity and and conditions associated with metabolic syndrome, such as diabetes. Obesity is the most important risk factor for endometrial cancer, and as rates of obesity rise, so does the incidence of endometrial cancer. Surgery is the mainstay of initial management of endometrial cancer, and staging now includes sentinel lymph-node mapping, along with a minimally invasive surgical approach for removal of the uterus, fallopian tubes, and ovaries. Fortunately, 75% of patients with endometrial cancer have International Federation of Gynecologic and Obstetrics (FIGO) stage I disease, and 5-year overall survival rates exceed 90%. High-risk stage I patients are often recommended to receive adjuvant therapy and women with locally advanced disease and/or distant disease typically require multimodality treatment that can include some combination of surgery, chemotherapy, and radiotherapy. Endometrial cancer is more often being detected in young obese women. In women of childbearing age in whom endometrial cancer is diagnosed and wish to retain their ability to have children, a conservative alternative to hysterectomy for these women is the use of oral progestin or a levonorgestrel intrauterine system (LNG-IUS).