ENDOMETRIAL CANCER

Carcinoma of the uterine corpus (endometrial cancer) remains the gynec ologic malignant disease with the highest annual prevalence in the Uni ted States. The most common histologic type is adenocarcinoma, althoug h more aggressive variants (e.g., papillary serous carcinoma and clear cell carcinoma) have been identified. Risk factors that are strongly associated with the development of endometrial cancer include tamoxife n therapy, obesity, and stimulation from unopposed estrogen (from exog enous sources or endogenously secreting ovarian tumors). The current s taging system of the International Federation of Gynecology and Obstet rics is based on surgical-pathologic findings. Survival has been direc tly correlated with tumor stage in this staging system. The cornerston e of therapy is total abdominal hysterectomy with bilateral salpingo-o ophorectomy. Pelvic and para-aortic lymphadenectomy may provide additi onal prognostic information but probably does not confer a therapeutic advantage. Moreover, such nodal dissections predispose to the develop ment of complications, especially in women who subsequently receive pe lvic irradiation. Other than surgical treatment, irradiation is the si ngle most active therapy for endometrial carcinoma. In fact, some wome n who are not candidates for hysterectomy because of medical contraind ications can be cured with radiation alone. Adjuvant therapy following hysterectomy is based on patient- and tumor-related features that pro vided prognostic information for incidence and pattern of recurrence. Adjuvant treatment usually includes pelvic irradiation for selected pa tients. Current investigational strategies are directed at the role of whole-abdomen irradiation, extended-field irradiation, and systemic c hemotherapy. The most active systemic agents include cisplatin, doxo-r ubicin, paclitaxel, and progestins.