Endometrial Cancer and Uterine Sarcoma
- Endometrial cancer: malignancy of the endometrial lining of the uterus
- Two types
- Type I: estrogen-dependent, grade 1 or grade 2, better prognosis, endometrioid histology
- Two types
- Cell types: adenocarcinoma, adenosquamous (malignant squamous elements), clear cell, and papillary serous
- Sarcomas: malignancy of the uterine mesenchyme and mixed tumors
- Mixed müllerian sarcoma (carcinosarcoma): Heterologous sarcoma elements are not native to the müllerian system (e.g., cartilage or bone); homologous sarcoma elements are native to the müllerian system (40–50% prevalence of all sarcomas).
- Leiomyosarcoma develops in the myometrium, characterized by cellular atypic mitoses and coagulative necrosis (30% prevalence of all sarcomas).
- Endometrial stromal sarcoma develops from the stromal component of the endometrium (15% prevalence of all sarcomas).
- Poorer prognosis (2)[C]
- Predominant age
- 70% of endometrial cancer is stage I at the time of diagnosis.
- System(s) affected: reproductive
- Synonym(s): uterine cancer; endometrial cancer; corpus cancer
This malignancy is not associated with pregnancy.
- Endometrial cancer is the most common gynecologic malignancy, fourth most common cancer in women, and eighth leading cause of cancer-related death in women worldwide.
- In the United States, it is estimated that endometrial cancer will account for 61,380 new cases and 10,920 deaths in 2017 according to SEER database.
- Incidence higher in Caucasian than African American, but African Americans have stage matched higher mortality (3).
Approximately 500,000 women in the United States
Etiology and Pathophysiology
Continuous estrogen stimulation unopposed by progesterone
- Endometrial: unopposed estrogen
- Estrogen replacement therapy without concomitant progesterone increases the risk. Addition of progesterone decreases risk to that of general population.
- Sarcomas: etiology unknown
- Endometrial: Lynch syndrome (hereditary nonpolyposis colorectal cancer); lifetime risk up to 30% (3); Cowden syndrome
- Sarcoma: African American, higher incidence of leiomyosarcoma, childhood retinoblastoma survivors
- Early menarche/late menopause
- Personal or family history of colon or reproductive system cancer
- Diabetes mellitus
- Polycystic ovarian syndrome
- Increasing age
- Estrogen-secreting tumor
- Endometrial hyperplasia
- Unopposed estrogens
- Tamoxifen use
- In young women who are obese or anovulatory, the risk of endometrial cancer can be reduced by taking oral contraceptive pills, permanently losing weight, or taking cyclic progesterone to prevent unopposed estrogen’s effects on the uterus.
- Estrogen replacement therapy should always include progesterone unless the woman has had a hysterectomy.
- Cigarette smoking has been associated with a lower risk of type I endometrial cancer; however, it is not recommended secondary to its many health risks and increase risk of type II endometrial cancer.
Commonly Associated Conditions
- Endometrial hyperplasia: 1–25% will progress to endometrial adenocarcinoma:
- Simple without atypia
- Complex without atypia
- Simple with atypia
- Complex with atypia
- 43% with complex hyperplasia with atypia have concurrent endometrial cancer.
- Endometrial cancer patients should be screened regularly for breast and colon cancer per routine screening guidelines.
- Patients who have breast or colon cancer are at increased risk for endometrial cancer.
- Granulosa cell tumors of the ovary produce estrogen; these patients will have an increased risk of endometrial cancer.
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Domino, Frank J., et al., editors. "Endometrial Cancer and Uterine Sarcoma." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116206/all/Endometrial_Cancer_and_Uterine_Sarcoma.
Endometrial Cancer and Uterine Sarcoma. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116206/all/Endometrial_Cancer_and_Uterine_Sarcoma. Accessed May 31, 2023.
Endometrial Cancer and Uterine Sarcoma. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116206/all/Endometrial_Cancer_and_Uterine_Sarcoma
Endometrial Cancer and Uterine Sarcoma [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116206/all/Endometrial_Cancer_and_Uterine_Sarcoma.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Endometrial Cancer and Uterine Sarcoma ID - 116206 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116206/all/Endometrial_Cancer_and_Uterine_Sarcoma PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -