Endometrial cancer or cancer of the uterine corpus is a neoplasm affecting the inside lining of the uterus (endometrium). It is the most frequent occurring genital cancer in women. In the United States, while it’s occurrence is approximately 4 times greater than cervical cancer, less than 20% of women will die from the disease. Mortality is significantly greater in African-American women. Genetic predisposition is supported by an increased risk of developing endometrial cancer in patients with a positive family history of the disease. Women who themselves had breast or ovarian cancer are also at a greater risk of developing endometrial cancer.
About 75% of endometrial cancers will first appear after menopause. In postmenopausal women, the most common presenting symptom is postmenopausal vaginal bleeding. The most common symptom in the 25% of women who will develop endometrial cancer before they reach menopause is irregular vaginal bleeding. Approximately 5% of endometrial cancers appear before age 40. When detected early, a patient with endometrial cancer has a favorable prognosis for cure. Risk factors associated with an increased risk for endometrial cancer include:
Nulliparity (no pregnancy)
Unopposed estrogen therapy
Personal history of breast, colon or ovarian cancer
Hereditary nonpolyposis colon cancer (HNPCC)
Unopposed estrogen (ingested or produced endogenously) appear to be the most frequent contributing risk factor associated with endometrial cancer. Obesity and anovulation appear to have an endogenous source of estrogen production. Tamoxifen (used for breast cancer treatment) appear to have an anti-estrogenic effect on the breast and an estrogenic effect on the endometrium. Estrogen related endometrial cancers tend to be well differentiated and usually progress from endometrial hyperplasia to cancer over a period of years. They tend to have a better prognosis than the endometrial cancer that appears in a setting of atrophic or inert endometrium.
Premalignant lesions of the endometrium have been identified. The most important is ‘endometrial hyperplasia’ and involves a proliferation of the endometrial glands with varying degrees of architectural and cytologic abnormalities. They include:
Simple hyperplasia (increased number of glands)
Complex hyperplasia (crowded glands)
Simple hyperplasia with atypia (prominent nucleoli)
Complex hyperplasia with atypia (crowded glands with prominent nucleoli)
After menopause, the endometrium (uterine lining) progressively atrophies and becomes thinner (less than 5 mm). Ultrasound (abdominal or vaginal), computed tomography (CT) scan and magnetic resonance imaging (MRI) can detect abnormal thickening of the endometrium. The upper limits of normal thickness in a postmenopausal woman has been suggested at 8 mm regardless of any ingestion of external hormonal therapy. Endometrial hyperplasia is usually accompanied by increased endometrial thickening. Endometrial biopsy (office procedure) or a dilatation and curettage (D&C) are the preferred diagnostic methods to obtain tissue for pathological evaluation.
The most common types of endometrial cancers include:
Endometrioid adenocarcinoma (~ 80%)
Serous papillary carcinoma (5%-10%)
Clear cell carcinoma (less than 5%)
Other (mucinous, squamous cell, small cell)
Prognosis for cure of endometrial cancer is proportionally related to the stage at the time of diagnosis. Staging is performed with the aid of CT and MRI include:
Stage I: Cancer confined to the corpus of the uterus
o Stage IA: Tumor limited to the endometrium o Stage IB: Tumor extends into less than one half the width of the myometrium (muscle of the uterus) o Stage IC: Tumor extends into one half or more of the myometrial width
Stage II: Cancer involving the corpus and cervix, without extrauterine
spread o Stage IIA: Cancer extends only to the endocervical glands of the cervix o Stage IIB: Cancer extends into the fibromuscular tissue of the cervix
Stage III: Cancer extending outside the uterus but confined to the true
pelvis o Stage IIIA: Cancer extends outside the uterus into the parametria o Stage IIIB: Vaginal metastasis of the endometrial cancer are present o Stage IIIC: Enlarged pelvic and/or para-aortic lymph nodes present
Stage IV: Cancer invading the bladder or bowel mucosa and/or
spreading outside the true pelvis o Stage IVA: Tumor invasion into the bladder or bowel mucosa o Stage IVB: Metastasis outside the true pelvis
If you believe that you or your loved have been misdiagnosed or wrongly treated for endometrial cancer and suspect the injury may be the result of a gynecologic error that was diagnosable, avoidable and/or preventable, you may have a valid cause of action. The injury may be the result of a medical provider's mistake in handling your gynecologic condition and the result of medical negligence. Dr. Borten has over 35 years of experience as an obstetrician and gynecologic surgeon to fully evaluate the merits of your potential case. Allow the Boston area medical malpractice attorneys at Gorovitz & Borten help you assert your rights and get the compensation you deserve.
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