Endometrial Cancer
Endometrial carcinoma in the United States is the most common gynecologic invasive malignancy of the female genital tract; 37,200 new cases in 2006, about 6,400 deaths in 2006. In fact this total of 37,200 is about equal to cases of ovarian carcinoma and cervical carcinoma combined. The difference is about 1,000 cases total. So this is a very common invasive malignancy in the United States that’s not often seen by the internist. The reason it is not often seen is illustrated in the death rate, which is very low compared to the number of new cases that you see, because most of these patients are going to be diagnosed as stage I grade I and cured surgically.
Pathologically, we are talking about adenocarcinomas. Over 70% of these tumors will be adenocarcinoma. There are some poor prognosis cell types you need to be aware of. These are actually subtypes of adenocarcinoma. Papillary serous tumors of the uterus are bad actors, as are clear cell carcinomas. Now no one can tell you how to approach these differently to make a difference in the outcome. It’s just like the mucinous and clear cells in ovary carcinoma, but we do recognize these as bad risk subtypes and there is an emerging interest now about studying these as a separate disease entity. Histologic grade is extremely important in the other cell types in predicting outcome, as we will show you in just a few moments.