[Algorithm of clinical aspects and pathology of endometrial carcinoma]

The carcinoma of the endometrium is the most common malignancy seen in the female pelvic genital organs. Important risk factors are age and unopposed estrogen (both endogenous and exogenous). In comparison, the association of antiestrogens (e.g., tamoxifen) and endometrial cancer is rather small, as yet. Fortunately, survival is high because the majority of patients have in common the presence of a low grade, low stage carcinoma of the endometroid type which gives rise to vaginal bleeding and forces the patients to attend the gynecologist. Special screening studies (e.g. vaginal sonography) to evaluate the endometrium are not indicated in the asymptomatic patient without risk factors. Tumor type, grading, and--most importantly--the depth of myoinvasion and the extent of extrauterine disease are the prognostic indicators that allow differential treatment, and help to identify patients at high risk vs. low risk for recurrent disease. Investigations of growth fraction, ploidy, steroid receptors, K-ras or p53 may be a supplement for dissecting special subgroups, but do not influence the clinical regimen, as yet. Most patients with stage I cancer are cured by surgery alone. Patients successfully treated for endometrial cancer should enjoy the benefits of estrogen replacement therapy, since they do not bear a risk of increased recurrence of their disease. Radiation therapy will be given to patients with incomplete resection of pelvic disease and/or extensive lymphonodal involvement, especially paraaortal lymph node metastasis. As yet, there is no rationale for an adjuvant hormone-(gestagen-) or chemotherapy. An exception, however, is the (mostly palliative) treatment of recurrent disease.