Hormonal interactions in endometrial cancer

Endometrial cancer (EC) is the most frequent malignant tumor of the female genital tract. Increasing evidence suggests that at least two different typ es of EC exist. Type I is associated with an endocrine milieu of estrogen p redominance. These tumors are of endometrioid histology and develop from en dometrial hyperplasia. They have a good prognosis and are sensitive to endo crine manipulation. Type II EC is not associated with a history of unoppose d estrogens and develops from the atrophic endometrium of elderly women. Th ey are of serous histology, have a poor prognosis, and do not react to endo crine manipulation. Both types of EC probably differ markedly with regard t o the molecular mechanisms of malignant transformation. This article review s reproductive and lifestyle factors modifying the risk of developing type I EC, including the use of hormonal contraceptives, hormone replacement the rapy and tamoxifen. The roles of established and novel therapies for precan cerous lesions and for invasive EC in the adjuvant and palliative settings are discussed.