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Sean C. Dowdy Andrea Mariani John R. Lurain
Most risk factors for the development of endometrial carcinoma are related to prolonged, unopposed estrogen stimulation.
Office endometrial aspiration biopsy is the accepted first step in evaluating a woman with abnormal uterine bleeding or suspected endometrial pathology.
Serous and clear cell endometrial carcinomas make up less than 10% of endometrial cancers, yet account for more than one-half of all endometrial cancer deaths.
Most patients with endometrial cancer should undergo surgical staging, including hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and peritoneal cytology. Lymphadenectomy may be omitted in patients with negligible risk of lymphatic spread.
The most important adverse prognostic variables in endometrial cancer are advancing patient age, nonendometrioid or grade 3 histology, deep myometrial invasion, lymphovascular space invasion, large tumor size, cervical extension, lymph node metastasis, and intraperitoneal spread.
Postoperative adjuvant radiotherapy in selected patients with endometrial cancer decreases the risk of local vaginal/pelvic recurrence and improves disease-free survival.
Overall 5-year survival rate in endometrial cancer is approximately 75%.
Uterine sarcomas are, in general, the most malignant group of uterine tumors and differ from endometrial cancers with regard to risk factors, diagnosis, clinical behavior, pattern of spread, and management.