Endometrial Cancer

Etiology

Endometrial cancer is one of the most common cancers in women. In the Western world, it ranks as the fourth most common cancer among women and the most prevalent cancer of the female genital tract. In Switzerland, about 1,000 women are diagnosed annually, primarily postmenopausal, with the average age of onset at 63 years. Globally, it stands as the sixth most common cancer in women, with approximately 320,000 new cases and about 76,000 deaths each year. Mortality rates vary with the disease stage, with early detection offering a favorable prognosis and a global five-year survival rate of about 80%.

Disease Forms

There are two types of endometrial carcinomas:

• Estrogen-dependent carcinoma (Type I)
• Estrogen-independent carcinoma (Type II)

Risk Factors

Confirmed risk factors for the carcinogenesis of Type I endometrial carcinoma include:

• Long-term intake of estrogens without progestogen protection
• Hormone therapy with less than 12 days per month of progestogen administration
• Metabolic syndrome with obesity (BMI > 25 kg/m^2)
• Diabetes mellitus
• Polycystic ovary syndrome (PCOS)
• Prolonged menstrual life
• Nulliparity
• Personal history of breast cancer
• Elevated serum estradiol concentrations
• Tamoxifen therapy

Reducing the risk of developing endometrial carcinoma:

• Multiparity
• Smoking
• Physical exertion
• Contraceptive use
• Lifelong soy-rich diet

Diagnosis and Therapy

Diagnostics

For the clarification of any postmenopausal bleeding and abnormal bleeding in premenopausal patients with any of the risk factors mentioned: • Gynecological examination to determine if the bleeding originates from the uterus and to assess if the cancer has extended beyond the uterus. Transvaginal sonography is used to evaluate the endometrium and rule out other pathological processes in the pelvic area. • In postmenopausal patients with uterine bleeding, an endometrial thickness > 5 mm is considered suspicious. • For postmenopausal patients on hormone therapy (including SERM therapy) and premenopausal patients, measuring endometrial thickness alone is not diagnostically conclusive. • Hysteroscopy and fractional curettage (scraping) are generally required.

Therapy

The treatment of endometrial carcinoma depends on factors such as the stage of the disease, tumor size and grade, as well as the patient's age and general condition. For most women with endometrial carcinoma, the primary treatment is the removal of the uterus and ovaries. In early stages (Stages I and II), surgery alone may suffice, while in advanced stages (Stages III and IV), additional radiotherapy and/or chemotherapy may be required. Hormone therapy with progestin preparations can be beneficial in some cases. It is used in patients with advanced or metastatic endometrial carcinoma who are not candidates for surgery or radiation therapy. Survival rates for endometrial carcinoma depend heavily on the stage at diagnosis. For patients in early stages (I and II), the five-year survival rate is around 90%, significantly lower in advanced stages (III and IV). Close follow-up and regular check-ups are crucial for early detection and treatment of any recurrence.