Uterine Cancer PDF

Preface

In the developed world, endometrial cancer is the most common gynecological malignancy. Overall survival rates of approximately 75% suggest that this cancer has a favorable prognosis, but with one-quarter of patients dead within five years of diagnosis, this is no time for therapeutic complacency. Our knowledge about extrauterine spread of disease apparently confined to the uterus has led to changes in staging criteria, and a therapeutic as well as a diagnostic role for lymphadenectomy has been suggested. The role of radiotherapy has been defined further and it is accepted by many that ‘‘postoperative radiotherapy for (nearly) all'' is not necessary. However, we do not know the best treatment for serous papillary or clear cell tumors and the place of cytotoxic, and for that matter hormonal therapy, has not been established. Molecular biology findings suggest that endometrial cancer evolves through a number of pathways—inactivation of tumor suppressor genes, activation of oncogenes, etc. Further studies should lead to improvements in prevention, detection, and treatment. This may be particularly true in cases of endometrial cancer associated with hereditary nonpolyposis colorectal cancer. Most cases of endometrial cancer are estrogen associated and tamoxifen is a known endometrial mutagen. Tamoxifen use is likely to increase as more women are screened for breast cancer and women at high risk of the disease are treated prophylactically. In addition to chapters reviewing our present knowledge of all aspects of endometrial cancer, some authorities have been asked to predict future directions in management.