Uterine cancer deaths could soon outnumber deaths from ovarian cancer. Uterine cancer will affect about 66,200 women in 2023 in the U.S. — and around 13,000 will die from the disease annually. Uterine cancer, also known as womb cancer, refers to cancers that develop in the uterus. The most common type is endometrial which originates in the lining of the uterus, the endometrium and account for about 95% of all cases; uterine sarcoma, which is a rarer type, develops in the muscles or other tissues of the uterus. The average age at diagnosis is 65 years old. The risk factors for uterine cancer include older age, obesity, diabetes mellitus, never having been pregnant, late menopause, unopposed estrogen intake, a history of breast cancer, and the use of tamoxifen.
Endometrial cancer is closely linked to estrogen levels especially unopposed estrogen. Unopposed estrogen occurs in obese women because androgens found in adipose (fat) tissue is converted to estrogens by the enzyme aromatase. Paradoxically, tamoxifen which is an antiestrogen in the breast and is used to treat breast cancer acts as an unopposed estrogen in endometrium and can cause endometrial cancer while being used to treat breast cancer. Early menarche and late menopause increase lifetime expose to estrogen and increase the risk of endometrial cancer.
The predominant symptom of endometrial cancer is postmenopausal uterine bleeding, but abnormal uterine bleeding in pre- or perimenopausal women can also occur. Keeping in mind that most cases of postmenopausal bleeding are due to benign causes and only 10–15% are malignant. One out of eight postmenopausal women, suffering from uterine bleeding, will ultimately be diagnosed with endometrial cancer.
All women with abnormal uterine bleeding should undergo proper clinical and gynecological examination, which should be supplemented by transvaginal ultrasonography. Endometrial thickness ≥ 5 mm is the cut-off point indicating further investigation for postmenopausal women. The gold standard for endometrial biopsy and histological confirmation of endometrial cancer are curettage (D&C) and hysteroscopy, but some imaging methods (CT, MRI) can provide useful information about myometrial invasion, (the muscle of the uterus) cervical involvement, lymph node status, and regional or distant metastasis.
Although endometrial cancer management remains challenging, a deeper understanding of the genetic diversity as well as the drivers of the various pathogenic states of this disease has led to development of divergent management approaches in an effort to improve therapeutic precision in this complex malignancy. Depending on the nature of the cancer progestins, aromatase inhibitors and Selective Estrogen Receptor Modulators SERMs may be prescribed.
