Cancer de endometrio

Páginas: 16 (3965 palabras) Publicado: 25 de julio de 2010
Endometrial Cancer
EDWARD M. BUCHANAN, MD; LARA CARSON WEINSTEIN, MD; and CHRISTINA HILLSON, MD Thomas Jefferson University, Philadelphia, Pennsylvania

Endometrial cancer is the leading cause of gynecologic cancer in the United States. Etiologically, endometrial carcinoma usually results from unopposed estrogen stimulation of the endometrium, although non–estrogen-related forms occur aswell. The most common presentation of endometrial cancer is postmenopausal bleeding. A variety of diagnostic modalities are available to aid in the detection of the disease, each with its own strengths and limitations. These modalities include endometrial biopsy, ultrasonography, saline infusion sonography, and hysteroscopy. A definitive diagnosis requires pathologic confirmation via endometrial biopsyor dilatation and curettage. Surgical staging of endometrial cancer will dictate how physicians manage the condition. For most women, staging and initial treatment are accomplished with total hysterectomy, bilateral salpingooophorectomy, and peritoneal washings. Surgery, radiation, and chemotherapy play a role in treatment, depending on tumor stage and grade. At present, there are norecommendations for screening the general population. (Am Fam Physician. 2009;80(10):1075-1080, 10871088. Copyright © 2009 American Academy of Family Physicians.)
Patient information: A handout on endometrial cancer, written by the authors of this article, is provided on page 1087. This article exemplifies the AAFP 2009 Annual Clinical Focus on management of chronic illness.

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ndometrial cancer iscurrently the most common gynecologic malignancy in the United States and the fourth most common cancer among women. The American Cancer Society estimates that there will be 42,160 new cases of uterine cancer in 2009 and 7,780 related deaths.1 Ninety percent of cases occur in women older than 50 years, and the median age at diagnosis is 62 years.2 Endometrial cancer is more common among white womenthan black women, yet mortality rates are higher in the latter. The overall annual mortality rate in the United States has increased more than 100 percent during the past two decades and is currently four deaths per 100,000 women per year.1,3 Pathogenesis Endometrial cancer is characterized by neoplasia of the glandular elements of the endometrium and is classified as type I or type II based onhistologic properties. Type I, also called the endometrioid type because of its histologic similarity to the endometrium, accounts for more than 75 percent of cases.4

Most type I tumors occur in the setting of unopposed estrogen stimulation, leading to endometrial hyperplasia. Previously, hyperplasia was thought to progress along a continuum that led to endometrial cancer. Recent studies showthat although some hyperplasias do progress to adenocarcinoma, others coexist with endometrial cancer.5 The probability of endometrial hyperplasia progressing to adenocarcinoma is greater in patients who have a higher degree of cytologic atypia, as described by the World Health Organization classification system.5 Simple hyperplasia without cellular atypia has a 1 percent probability of progressingto carcinoma if left untreated; with cellular atypia, the probability is 8 percent.5 Complex hyperplasia without cellular atypia has a 3 percent probability of progressing; with cellular atypia, the probability is 29 percent.5 Unlike type I tumors, type II lesions are not related to estrogen exposure or endometrial hyperplasia. These tumors manifest later in life, are typically diagnosed at amore advanced stage, and carry a poorer prognosis. Type II tumors include serous, clear cell,

November 15, 2009 individual user ofNumbersite. All other rights reserved. Contact copyrights@aafp.org for copyright questions and/orFamily Physician 1075 www.aafp.org/afp American permission requests. cial use of one Volume 80, the Web 10

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