Skip to main content
SpringerLink
Log in

Carcinoma of the Endometrium

  • Review Article
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

The incidence of endometrial cancer is highest among relatively affluent Caucasians. Although it has a comparatively low mortality rate compared with other gynaecological cancers, it is capable of aggressive behaviour. Endometrial cancer is uncommon in premenopausal women. The incidence rises with age and is significantly increased when there is exposure to unopposed estrogen, including hormone replacement therapy (HRT). Even when HRT is given in the form of estrogen and cyclical progesterone there is probably some increased risk. The long term use of tamoxifen for breast cancer is also associated with an increased incidence of endometrial cancer.

Transvaginal ultrasound and pipelle or hysteroscopy endometrial biopsies are tending to replace the traditional dilation and curettage in establishing a diagnosis.

90% of endometrial tumours are surgically resectable on presentation. This remains the first line management —minimally, a total abdominal hysterectomy and bi-lateral salpingo oophorectomy. Prognostic factors include the histological grade, the depth of invasion of the myometrium, the presence or absence of lymph-vascular space invasion and involved regional nodes, tumour volume, and the presence or absence of involvement of the cervix. The pelvis is a major anatomical site at risk of recurrence, and since cytotoxic chemotherapy and hormone therapies have limited effectiveness, radiotherapy is the adjuvant therapy of choice where adverse prognostic factors are present.

A move towards more radical surgery —the addition of lymphadenectomy with a total abdominal hysterectomy and bi-lateral salpingo oophorectomy, may modify the value of adjuvant therapy and has highlighted the need to demonstrate the exact place of post operative radiotherapy in the management of endometrial cancer. The ASTEC trial in the UK, run by the Medical Research Council, has the dual aims of determining the benefit of lymphadenectomy and of post operative adjuvant radiotherapy in patients with endometrial cancer confined to the corpus.

Patients who are not medically fit for surgery or who have inoperable disease are managed with radical radiotherapy but the results in both these groups are inferior to those obtained with radical surgery. Spread outside the pelvis to paraaortic nodes may still be salvaged with local irradiation, but systemic disease is incurable and treatment is largely palliative including consideration of local irradiation, hormone therapy or chemotherapy for symptomatic relief.

As reliable techniques for diagnosis are refined an even larger proportion of patients will be diagnosed with early disease. This, together with the development of new cytotoxic agents and sophisticated radiotherapy techniques to reduce normal tissue morbidity, will require the establishment of further clinical trials to refine optimal management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I

Similar content being viewed by others

Notes

  1. MRC Cancer Trials Office, 5 Shaftesbury Road, Cambridge CB2 2BW; Fax 01 223 311 844.

References

  1. Blake P, Lamber H, Crawford R. Gynaecological oncology. Oxford: Oxford University Press, 1998

    Book  Google Scholar 

  2. DiSiaia P, Creasman WT, DiSiaia PJ. Clinical gynecological oncology. 5th ed. St Louis (MO): Mosby-Year Book, 1997

    Google Scholar 

  3. Pike MC. Age related factors in cancers of the breast, ovary and endometrium. J Chronic Dis 1987; 40 Suppl. 2: 595–695

    Google Scholar 

  4. Pettersson B, Adami HO, Bergstrom R, et al. Menstrual span —increases in risk as menstruation span increases. Acta Obstet Gynaecol Scand 1986; 65(3): 247–55

    Article  CAS  Google Scholar 

  5. Hershcopf RJ, Bradlow HL. Obesity, diet, endogenous estrogens and the risk of hormone sensitive cancer. Am J Clin Nutr 1997; 45(1): 283–9

    Google Scholar 

  6. Levi F, La Vecchia C, Gulie C, et al. Cigarette smoking and the risk of endometrial cancer. Eur J Cancer Clin Oncol 1987; 23(7): 1025–9

    Article  PubMed  CAS  Google Scholar 

  7. Lawrence C, Tessaro I, Durgerian S, et al. Smoking, body weight and early stage endometrial cancer. Cancer 1987; 59(9): 1665–9

    Article  PubMed  CAS  Google Scholar 

  8. Stockwell HG, Lyman GH. Cigarette smoking and the risk of family reproductive cancer. Am J Obstet Gynaecol 1987; 157(1): 35–40

    CAS  Google Scholar 

  9. Franks AL, Kendrick JS, Tyler CW Jr, et al. Post menopausal smoking, estrogen replacement therapy and the risk of endometrial cancer. Am J Obstet Gynaecol 1987; 156(1): 20–3

    CAS  Google Scholar 

  10. The Writing group for the PEPI Trial. The effects of hormone replacement therapy on endometrial histology in postmenopausal women: the postmenopausal estrogen/progestin intervention trial (PEPI). JAMA 1996; 275(5): 370–75

    Article  Google Scholar 

  11. Gruber DM, Wagner G, Kurz C, et al. Endometrial cancer after combined hormone replacement therapy. Mativitas: University of Vienna, 1999 Mar; 31 (3) 237–40

    Google Scholar 

  12. Weiderpass E, Adami HO, Baron JA, et al. Risk of endometrial cancerfollowing estrogen replacement therapy with and without progestins.J National Cancer Instit Sweden 1999; 91(13): 1131–7

    Article  CAS  Google Scholar 

  13. Ewartz M, Machado SG, Boice JD, et al. Endometrial cancer following treatment for breast cancer —a case control study in Denmark. Br J Cancer 1984; 50(5): 687–92

    Article  Google Scholar 

  14. Berliere M, Galant C, Donnez J, et al. The potentially oncogenic effect of tamoxifen on the endometrium. Hum Reprod 1999; 14(5): 1381–3

    Article  PubMed  CAS  Google Scholar 

  15. Bergman L, Beelen ML, Gallee MP, et al. Risk and prognosis of endometrial cancer after tamoxifen for breast cancer. Comprehensive Cancer Centres’ ALERT Group. Assessment of liver and endometrial cancer risk following tamoxifen. Lancet 2000 Sep; 356(8233): 881–8

    CAS  Google Scholar 

  16. Simopoulos AP. Fat intake, obesity and cancer of the breast and endometrium. MED Oncology Tumour Pharmacotherapy 1985; 2(3): 125–35

    CAS  Google Scholar 

  17. Vaccarello L, Apte SM, Copeland LJ, et al. Endometrial cancer associated with pregnancy —a report of 3 cases and a review of the literature. Columbus (OH): Division of Gynaecological Oncology, The Arthur G. James Hospital. Gynecol Oncol 1999 Jul; 74(1): 118–22

    CAS  Google Scholar 

  18. Heffner HM, Freedman AN, Asirwatham JE, et al. The prognostic significance of P53, PCNA and C-erb B-2 in endometrial adenocarcinoma. Eur J Gynaecol Oncol 1999; 20(1): 8–12

    PubMed  CAS  Google Scholar 

  19. Ozsaran AA, Turker S, Dikmen Y, et al. P53 staining as a prognostic indicator in endometrial carcinoma. Eur J Gynaecol Oncol 1999; 20(2): 156–9

    PubMed  CAS  Google Scholar 

  20. Noumoff JS. Endometrial adenocarcinoma. Philadelphia (PN): University of Pennsylvania School of Medicine, 1993 Jun

    Book  Google Scholar 

  21. Peckham M, Pinedo H, Veronesi U, editors. Oxford textbook of oncology. Oxford: Oxford University Press, 1996

    Google Scholar 

  22. Kamura T, Yahata H, Shigematsu T, et al. P53 staining as a prognostic indicator in endometrial carcin. Predicting pelvis lymph node metastases in endometrial cancer. Gynaecol Oncol 1999; 72(3): 387–391

    CAS  Google Scholar 

  23. Feltmate CM, Duska LR, Chang Y, et al. Predictors of recurrence in Surgical Stage II endometrial adenocarcinoma. Gynaecol Oncol 1999; 73(3): 407–411

    Article  CAS  Google Scholar 

  24. Rose PG, Sommers RM, Reale FR, et al. Serial serum CA125 measurements for evaluation of recurrences in patients with endometrial carcinoma. Obstet Gynaecol 1994; 84(1): 12–6

    CAS  Google Scholar 

  25. Falcon O, Chirino R, Leon L, et al. Low levels of cathepsin dose associated with poor prognosis in endometrial cancer. Br J Cancer 1999; 79(3–4): 570–6

    Article  PubMed  CAS  Google Scholar 

  26. McCluggage WG, Maxwell P, Hamilton PW, et al. High metallothionein expression is associated with features predictive of aggressive behaviour on endometrial cancer. Histopathology 1999; 31(1): 51–5

    Article  Google Scholar 

  27. Baker VV. The molecular biology of endometrial cancer. Division of Gynaecological Oncology, University of Madigan Medical Centre. Clin Obstet Gynaecol 1996; 39(3): 707–15

    CAS  Google Scholar 

  28. Cicinelli E, Comi N, Scorcia P, et al. Hysteroscopy for diagnosis and treatment of endometrial adenocarcinoma precursors. A review of the literature. Eur J Gynaecol Oncol 1993; 14(5): 425–36

    CAS  Google Scholar 

  29. Youssif SN, McMillan DL. Outpatient endometrial biopsy —the pipelle. Br J Hosp Med 1995; 54(5): 198–201

    PubMed  CAS  Google Scholar 

  30. Zorbu CG, Cobanoglu O, Ekici E, et al. Pre-operative assessment of myometrial invasion of endometrial carcinoma by transvaginal ultra sonography. Mater Med Pol 1995; 27(1): 23–5

    Google Scholar 

  31. Workman RD, Wong DS, Pitts WC. Embolic vascular seeding of endometrial adenocarcinoma; a complication of hysteroscopic endometrial biopsy. Gynaecol Oncol 1999; 72(2): 261–4

    Article  CAS  Google Scholar 

  32. Graham J. The value of pre or post operative treatment by radium for carcinoma of the uterus. Surg Gynaecol Obstetr 1971 May; 132(5): 855–60

    CAS  Google Scholar 

  33. Partridge EE. Endometrial cancer: changing concepts in therapy. Surg Clin North Am 1991; 71(5): 991–1004

    PubMed  CAS  Google Scholar 

  34. Photopolos GJ. Surgicopathologic staging of endometrial adenocarcinoma. Curr Opin Obstet Gynaecol 1994: 6(1): 92–7

    Google Scholar 

  35. Patsner B. Routine retroperitoneal drainage is not required for uncomplicated pelvic lymphadenopathy for uterine cancer. Eur J Gynaecol Oncol 1999; 20(2): 87–9

    PubMed  CAS  Google Scholar 

  36. Thomas R, Blake P. Endometrial carcinoma: adjuvant locoregional therapy. Clin Oncol 1996; 8: 140–5

    Article  CAS  Google Scholar 

  37. Bond WH. Early uterine body carcinoma: has post-operative vaginal irradiation any value? Clin Radiol 1985; 36: 619–23

    Article  PubMed  CAS  Google Scholar 

  38. Roberts JA, Brunetto VL. A phase III randomised study of surgery plus adjunctive radiation therapy in intermediate risk endometrial adenocarcinoma (GOG No99). Gynaecol Oncol 1998; 68(1): 135

    Google Scholar 

  39. Creutzberg CL, Van Putten WLJ, Koper PC, et al. Surgery and post operative radiotherapy versus surgery alone for patients with Stage I endometrial carcinoma. Lancet 2000 Apr; 355(22): 1404–11

    Article  PubMed  CAS  Google Scholar 

  40. Bliss P, Cowie VJ. Endometrial carcinoma: does the addition of intra cavity vault caesium to external beam therapy post-operatively result in improved control or increased morbidity? Clin Oncol 1992; 4: 373–6

    Article  CAS  Google Scholar 

  41. Piver MS, Yazigi R, Blumenson L, et al. A prospective trial comparing hysterectomy, hysterectomy plus vaginal radium and uterine radium plus hysterectomy in Stage I endometrial carcinoma. Obstetr Gynaecol 1979; 54(1): 85–9

    Article  CAS  Google Scholar 

  42. Surwit EA, Joelsson I, Einholm N. Adjunctive radiation therapy in the management of Stage I cancer of the endometrium. Obstet Gynaecol 1981; 58: 590–5

    CAS  Google Scholar 

  43. Aalders J, Abeler V, Kolstad P, et al. Post operative irradiation and prognostic parameters in Stage I endometrial carcinoma. Obstetr Gynaecol 1980; 58: 419–27

    Google Scholar 

  44. DeCruze B, Guthrie D. Radiotherapy in poor risk patients with stage I cancer of the endometrium: results of not giving external beam radiotherapy. Clin Oncol 1999; 11: 252–4

    Article  CAS  Google Scholar 

  45. Fung MF, Krepart GV, Lotocki RJ, et al. Treatment of recurrent metastatic adenocarcinomas of the endometrium with cisplatin, doxorubicin, cyclophosphamide and medroxyprogesterone acetate. Obstet Gynaecol 1991; 78(6): 1033–8

    CAS  Google Scholar 

  46. Markman M, Kennedy A, Webster L, et al. Persistent chemo sensitivity to platinum and/or paclitaxel in metastatic endometrial carcinoma. Gynaecol Oncol 1999; 73(3): 422–3

    Article  CAS  Google Scholar 

  47. Rantanen V, Grenman S, Kulmala J, et al. Endometrial cancer cell lines are sensitive to Paclitaxel. Anti Cancer Res 1996; 16(11): 475–9

    CAS  Google Scholar 

  48. Lewis GC, Stack NH, Mortel R, et al. Adjuvant progestin therapy in the primary definitive treatment of endometrial cancer. Gynaecol Oncol 1974; 2(2–3): 368–76

    Article  Google Scholar 

  49. Kim YB, Holschneider CH, Ghosh K, et al. Progestin alone as primary treatment of endometrial carcinoma in pre-menopausal women. Cancer 1997; 79(2): 320–7

    Article  PubMed  CAS  Google Scholar 

  50. Kupelian PA, Eifel PJ, Tomos C, et al. Treatment of endometrial cancer with radiation alone. Int J Radiat Oncol Biol Physics 1993; 27(4): 817–24

    Article  CAS  Google Scholar 

  51. Kucera H. The value of and indications for radiotherapy in endometrial carcinoma. Strahlentherapie Oncologie 1991; 167(7): 381–6

    CAS  Google Scholar 

  52. Ahmadk Kim YH, Deppe G, Malon J, et al. Results of treatment of locally advanced carcinoma of the endometrium. Acta Oncologica 1990; 29(2): 203–9

    Article  Google Scholar 

  53. Kushner DM, Lurain JR, Fu TS, et al. Endometrial carcinoma metastatic to scalp: a case report and literature review. Gynaecol Oncol 1997; 65(3): 530–3

    Article  CAS  Google Scholar 

  54. Malicky ES, Kostic JK, Jacob JH, et al. Endometrial carcinoma presenting with an isolated osscous metastasis: a case report and review of literature. Eur J Gynaecol Oncol 1997; 18(6): 492–4

    PubMed  CAS  Google Scholar 

  55. Clarke SJ. Metastatic endometrial cancer in the foot: a case report. J Am Podiatr Med Assoc 1996; 86(7): 331–3

    PubMed  CAS  Google Scholar 

  56. Giardina VN, Morton BF, Potter GK, et al. Metastatic endometrial adenocarcinomas to the skin of the toe. Am J Dematopathol 1996; 18(1): 94–8

    Article  CAS  Google Scholar 

  57. Markopoulos C, Gogas H, Eleftheriou G, et al. Endometrial carcinoma arising in the scar of caesarean section. Eur J Gynaecol Oncol 1996; 17(6): 521–7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Charing Cross Hospital, Fulham Palace Rd, London, W6 8RF, England

    Barbara M. Southcott

Authors
  1. Barbara M. Southcott
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Southcott, B.M. Carcinoma of the Endometrium. Drugs 61, 1395–1405 (2001). https://doi.org/10.2165/00003495-200161100-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200161100-00003

Keywords

Search

Navigation