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INTRODUCTION

Epidemiology

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Epidemiology
Incidence: 61,880 (2019 U.S. estimate)
  27.5 per 100,000 women per year
Deaths: 12,160 (2019 U.S. estimate)
Median age at diagnosis: 63 years

Siegel RL et al. CA Cancer J Clin 2019;69:7–34

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed December 12, 2019]

Pathology

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Pathology
Endometrioid 75–80%
Serous ~10%
Clear cell <5%
Mucinous 1%
Squamous <1%
Mixed 10%
Carcinosarcoma <5%

Rare subtypes:

 Neuroendocrine carcinoma

 Dedifferentiated carcinoma

<1%
WHO Classification of tumors of the female reproductive organs (Kurman, Carcangiu, Herrington, Young (Eds). World Health Organization, 2014

Diagnosis

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Diagnosis
Abnormal uterine bleeding Endometrial curettage
Endometrial biopsy
No abnormal uterine bleeding, but other symptoms present Endometrial curettage and biopsy
Consider biopsy if distant disease suspected
Patients may present with nonspecific symptoms, including abdominal bloating, pain, or distention as well as constitutional symptoms

Staging and treatment evaluation

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Staging and treatment evaluation
All Patients Physical exam, including pelvic examination
Assessment of hereditary risk

CBC with platelet count

Chemistry panel

Consider CA–125 measurement
High-risk histologies (serous or clear cell cancer), suspected advanced disease, or confirmed stages III/IV CT chest/abdomen/pelvis, MRI pelvis, or other imaging (eg, PET scan)

Staging

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Staging
Staging outlined below is for uterine carcinomas and carcinosarcomas only.
FIGO Stage TNM Primary Tumor (T)
  TX Primary tumor cannot be assessed
  T0 No evidence of primary tumor
I T1 Tumor confined to corpus uteri (includes endocervical gland involvement)
IA T1a Tumor limited to endometrium or invades less than one-half of the myometrium
IB T1b Tumor invades one-half or more of the myometrium
II T2 Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus. Does NOT include endocervical glandular involvement
III T3 Tumor involves serosa, adnexa, vagina, or parametrium
IIIA T3a Tumor involves serosa and/or adnexa (direct extension or metastasis)
IIIB T3b Vaginal involvement (direct extension or metastasis) or parametrial involvement
IVA T4 Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)
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Staging
FIGO Stage TNM Category Regional Lymph Nodes (N)
  NX Regional lymph nodes cannot be assessed
  N0 No regional lymph node metastasis
  N0 (i+) Isolated tumor cells in regional lymph node(s) ≤0.2 mm
IIIC1 N1 Regional lymph node metastasis to pelvic lymph nodes
IIIC1 N1mi Regional lymph node metastasis (>0.2 mm but ≤2.0 mm in diameter) to pelvic lymph nodes
IIIC1 N1a Regional lymph node metastasis (>2.0 mm in diameter) to pelvic lymph nodes
IIIC2 N2 Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes
IIIC2 N2mi Regional ...

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