Cancer of the uterine endometrium (fundus or corpus) is the fourth most common cancer in women, with more than 54,870 new cases of uterine cancer diagnosed each year and more than 10,170 deaths. The disease occurs twice as often in Caucasian women as compared to African American women; however, African American women have a less favorable prognosis. Cumulative exposure to estrogen (without the use of progestin) is considered the major risk factor. Other risk factors include age above 55 years, obesity, early menarche, late menopause, nulliparity, anovulation, infertility, and diabetes as well as use of tamoxifen.
Most uterine cancers are endometrioid (i.e., originating in the lining of the uterus). Type 1, which accounts for 90% of cases, is estrogen related and occurs in younger, obese, and perimenopausal women; it is usually low grade with a favorable outcome. Type 2, which occurs in about 10% of cases, is high grade and usually serous cell or clear cell; older women and African American women are at higher risk for type 2. Type 3, which also occurs in about 10% of cases, is the hereditary or genetic type, some of which cases are related to the Lynch II syndrome (also known as hereditary non-polyposis colorectal cancer and associated with the occurrence of breast, ovarian, colon, endometrial, and other cancers throughout a family).
Treatment consists of surgical staging, total or radical hysterectomy, and bilateral salpingo-oophorectomy and node sampling. Cancer antigen 125 (CA125) levels must be monitored, because elevated levels are a significant predictor of extrauterine disease or metastasis. Adjuvant radiation may be used in a patient who is considered high risk. Recurrent lesions in the vagina are treated with surgery and radiation. Recurrent lesions beyond the vagina are treated with hormonal therapy or chemotherapy. Progestin therapy is used frequently.