The most common gynecologic cancer-61,180 cases are diagnosed in the United States and 12,160 pts die annually. It is primarily a disease of postmenopausal women. Obesity, altered menstrual cycles, infertility, late menopause, and postmenopausal bleeding are commonly encountered in women with endometrial cancer. Women taking tamoxifen to prevent breast cancer recurrence and those taking estrogen replacement therapy are at a modestly increased risk. Peak incidence is in the sixth and seventh decades.
Abnormal vaginal discharge (90%), abnormal vaginal bleeding (80%), and leukorrhea (10%) are the most common symptoms.
Endometrial cancers are adenocarcinomas in 75-80% of cases. The remaining cases include mucinous carcinoma; papillary serous carcinoma; and secretory, ciliate, and clear cell varieties. Prognosis depends on stage, histologic grade, and degree of myometrial invasion.
Total abdominal hysterectomy and bilateral salpingo-oophorectomy constitute both the staging procedure and the treatment of choice. The staging scheme and its influence on prognosis are shown in Table 74-1 Staging and Survival in Gynecologic Malignancies. About 75% of pts are stage I, 13% are stage II, 9% are stage III, and 3% are stage IV.
| TREATMENT | ||
Endometrial CancerIn women with poor histologic grade, deep myometrial invasion, or extensive involvement of the lower uterine segment or cervix, intracavitary or external-beam radiation therapy is given. If cervical invasion is deep, preoperative radiation therapy may improve the resectability of the tumor. Stage III disease is managed with surgery and radiation therapy. Stage IV disease is usually treated palliatively. Progestational agents such as hydroxyprogesterone or megestrol and the antiestrogen tamoxifen may produce responses in 20% of pts. Doxorubicin, 60 mg/m2 IV day 1, and cisplatin, 50 mg/m2 IV day 1, every 3 weeks for 8 cycles produces a 45% response rate. |