Introduction

Gynecologic malignancies account for approximately 15% of all new female cancers diagnosed in the US each year. Based upon US population estimates, 80 000 women were diagnosed with gynecologic cancers in 1998. In that same year, an estimated 27 000 women died as a result of these cancers. Worldwide, cervical cancer represents the second leading cause of cancer-related death among women, second only to breast cancer. In certain developing countries of the world, cervical cancer is the leading cause of death among women of reproductive age.

Endometrial cancer

In the US, endometrial cancer is the most common invasive neoplasm of the female genital tract. It is estimated that 36 000 new cases of endometrial cancer will be diagnosed this year, and that approximately 6000 women will die from their disease.

Endometrial cancer is predominantly a disorder of older women, with 75% of all cases arising in the postmenopausal age group (Table 28.1). The average age at diagnosis is 58 years. Only 2–5% of all cases of endometrial cancer are diagnosed in women less than 40 years of age.

Endometrial cancer arises as a result of unopposed estrogenic stimulation of the endometrial lining. A number of constitutional factors have been identified in women who develop endometrial cancer. These include obesity, nulliparity, early menarche, late menopause, diabetes, hypertension, gallbladder disease, unopposed exogenous estrogen therapy, and prior history of pelvic irradiation (Table 28.2). Protective factors that mitigate against the development of endometrial cancer include the use of combination oral contraceptives.