CLINICAL ASPECTS OF RISK IN WOMEN WITH ENDOMETRIAL CARCINOMA

Carcinoma of the endometrium is the most common gynecologic malignancy , expected to account for 33,000 new cases and 6,000 deaths in 1995. M ost endometrial cancers occur in postmenopausal women and produce abno rmal vaginal bleeding. Some women exhibit the premalignant changes of atypical endometrial hyperplasia before developing an overt carcinoma. Identified epidemiologic risk factors include obesity, diabetes melli tus, use of unopposed exogenous estrogens, estrogen-secreting tumors, and a reproductive history characterized by prolonged estrogenic predo minance. Diagnosis can be readily established by outpatient endometria l biopsy. Because clinical estimates of disease extent and spread are subject to substantial error, endometrial cancer is now a surgically s taged neoplasm. A well-defined set of surgicopathologic risk factors h ave been incorporated into the staging scheme. Women with extrauterine disease comprise about 20% of cases and are at greatest risk for tumo r recurrence and death from disease. Within the much larger group of w omen whose tumors are limited to the uterus, recurrence risk can be st ratified by cytologic grade, cell type, depth of myometrial invasion, and extension to the cervix. About two-thirds of women have low-risk d isease confined to the uterus when these criteria are employed, while the remaining one-third have high-risk subtypes. Recent areas of inves tigation have focused on molecular and genetic markers. Two clinical o bservations currently being examined are the poorer survival of Black women with uterine cancer and the apparent association of endometrial lesions with chronic tamoxifen suppression in women with breast carcin omas. (C) 1995 Wiley-Liss, Inc.