11,000 new cases per year 4.3% of female cancer incidence

Mortality

4,000 deaths per year

3.2% of female cancer mortality

Rates

Incidence per 100,000 11.9 Mortality per 100,000 5.0

Age

Significant increase beyond age 40 Over 75% of cases occur between ages 50-80

Trend last ten years

Incidence Not considered significant

Mortality Not considered significant

Other Features

1. There is a clinical syndrome suggesting the presence of an endocrinopathy which may characterize many women with endometrial carcinoma:

(a) Obesity

(b) Hypertension

(c) Diabetes mellitus

(d) Infertility

(e) Hirsutism

(f) Menstrual disturbances

2. The ratio of occurrence of endometrial carcinoma and carcinoma of the cervix is 1 to 3 or 1 to 4. Where cervical carcinoma declines in incidence and the population ages, the ratio between the two lesions tends to narrow.

Etiology

The fundamental etiology of carcinoma of the endometrium is unknown.

Many of the lesions do appear to arise from a background of cystic adenomatous hyperplasia or polyps of the endometrium, but the cause of these lesions is unknown.

There appears to be an increased incidence of endometrial cancer among those with:

1. Functioning ovarian tumors (the thecoma and granulosa cell types)

2. Significant exposure to local therapeutic radiation

3. A history of prolonged estrogenic hormone administration

The validity of these observations, especially the latter, requires more documentation and confirmation.

Pathology

A few general remarks may be made concerning endometrial carcinoma.

1. The vast majority of the lesions are adenocarcinoma; in those rare instances in which an epidermoid picture is superimposed, the lesion is referred to as an adenoacanthoma.

2. The lesions usually grow; toward the uterine cavity but may invade the myometrium or even the cervix. Eventually the serosa, adnexal tissues, bladder, and lower bowel may be involved.

3. As noted previously, the lesion frequently arises from a background of endometrial hyperplasia or polyps.

4. Recent work by Jordan and Bader suggests that certain patients with cervical atypias may subsequently develop endometrial lesions.