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Chapter 10: Endometrial Cancer

Maurie Markman

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    AMA Citation
    Markman M. Markman M Markman, Maurie.Endometrial Cancer. In: Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al.eds. Hematology-Oncology Therapy, 2e New York, NY: McGraw-Hill; . http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126322015. Accessed February 17, 2019.
    MLA Citation
    Markman M. Markman M Markman, Maurie.. "Endometrial Cancer." Hematology-Oncology Therapy, 2e Boyiadzis MM, Frame JN, Kohler DR, Fojo T. Boyiadzis M.M., Frame J.N., Kohler D.R., Fojo T Eds. Michael M. Boyiadzis, et al. New York, NY: McGraw-Hill, , http://hemonc.mhmedical.com/content.aspx?bookid=1611&sectionid=126322015.

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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 52,630 (Estimated new cases for 2014 in the United States) Stage at Presentation
Localized: 72% Stage I: 79%
24.3 per 100,000 women per year. Regional: 16% Stage II: 12.5%
Deaths: Estimated 8,590 in 2014  Distant:  8% Stage III: 13.3%
Median age at diagnosis: 62 years Unstaged:  4% Stage IV:  4%

Modified from Creasman WT et al. J Epidemiol Biostat 2001;6:47–86

Siegel R et al. CA Cancer J Clin 2014;64:9–29

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov (accessed in 2013)

Pathology

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Pathology

Endometrioid

  • Ciliated adenocarcinoma

  • Secretory adenocarcinoma

  • Adenocarcinoma with squamous differentiation–Adenosquamous

 75–80%
Serous <10%
Clear cell 4%
Mucinous 1%
Squamous <1%
Mixed 10%
Undifferentiated  

Kurman RJ, Ellenson LH, Ronnett BM editors. Blaustein's Pathology of the Female Genital Tract. 6th ed: Springer; 2011

Work-up

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Work-up
Stage I

H&P

CBC with platelet count

Chest x-ray

Cervical cytology
Stage II Consider endocervical curettage or cervical biopsy
Stages III/IV CA-125 MRI/CT as clinically indicated

Staging

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Staging
TNM Category FIGO Stage✫ Primary Tumor (T)
TX   Primary tumor cannot be assessed
T0   No evidence of primary tumor
Tis   Carcinoma in situ (preinvasive carcinoma)
T1 I Tumor confined to corpus uteri
T1a IA Tumor limited to endometrium or invades less than one-half of the myometrium
T1b IB Tumor invades one-half or more of the myometrium
T2 II Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus†
T3a IIIA Tumor involves serosa and/or adnexa (direct extension or metastasis)
T3b IIIB Vaginal involvement (direct extension or metastasis) or parametrial involvement
T4 IVA Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)

✫FIGO staging no longer includes stage 0 (Tis)

†Endocervical glandular involvement only should be considered as stage I and not stage II
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Staging
TNM Category FIGO Stage Regional Lymph Nodes (N)
NX   Regional lymph nodes cannot be assessed
N0   No regional lymph node metastasis
N1 IIIC1 Regional lymph node metastasis to pelvic lymph nodes
N2 IIIC2 Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes
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Staging
TNM Category FIGO Stage Distant Metastasis (M)
M0   No distant metastasis (no pathologic M0; use clinical M to complete stage group)
MI IVB Distant metastasis (includes metastasis to inguinal lymph nodes intraperitoneal disease, or lung, liver, or bone. It excludes metastasis to paraaortic lymph nodes, vagina, pelvic serosa, or adnexa)

 

Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC ...

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