Genital Cancers in Women: Uterine Cancer

There are two main types of uterine cancer. Endometrial carcinoma, the most commonly diagnosed genital cancer in women, accounts for most cases (more than 95%) and sarcoma comprises the remainder. Endometrial cancer primarily occurs in postmenopausal women. Risk factors include exposure to high levels of endogenous estrogen (eg, obesity, nulliparity, late menopause) or exogenous estrogen (eg, hormone replacement therapy, tamoxifen) and pelvic radiation. Genetics are involved in a small percentage of cases, notably among women in families with hereditary nonpolyposis colorectal cancer (HNPCC). More than 80% of patients with endometrial cancers present with abnormal uterine bleeding. Endometrial biopsy and transvaginal ultrasound are the first-line tests to evaluate bleeding. If the endometrial lining is thickened on ultrasound, endometrial biopsy is indicated. If symptoms persist after negative biopsy results, or if biopsy results are inadequate, hysteroscopy is performed for tissue sampling. Most patients with endometrial cancer are diagnosed early, when cancer is confined to the uterus. Hysterectomy is the treatment of choice in such cases. Treatment of advanced disease involves radiotherapy and/or chemotherapy. Perimenopausal women should be informed that abnormal bleeding could be a sign of cancer and should be evaluated. However, no routine screening is recommended except for women with HNPCC.