ABSTRACT
Endometrial cancer is the most common gynecological malignancy. There were approximately 39,300 new cases in 2002, and it is estimated that 6600 women died from this disease in the same year (1). This large difference is due to the fact that the majority of women will present to their physicians with symptoms that lead to early diagnosis. The primary treatment for patients with early-stage disease is surgery. Hysterectomy and oophorectomy with surgical staging are recommended for patients whose tumor grade, depth of invasion, cervical involvement, or histological subtype suggests that they are at high risk for extrauterine disease or recurrence. Modified radical or radical hysterectomy and oophorectomy are recommended for patients whose initial evaluation suggests clinical involvement of the cervix (2). These therapeutic modalities are limited by the elderly patient population and the morbidity of radical surgery (3). Patients with early-stage disease and low risk of recurrence experience a greater than 90% survival with surgical resection alone. For surgically treated patients at intermediate risk for recurrence, the current standard is to offer adjuvant therapy in the form of radiation (3). The estimated 12% of patients who present with advanced diseases are not curable with surgical intervention alone and will ultimately need chemotherapy to improve survivorship. In addition, those who have a recurrence of their tumor after surgery and radiation therapy are candidates for chemotherapy. The majority of studies performed to evaluate the role of chemotherapy in women with endometrial cancer has been performed on this patient population. This group of patients will be the primary focus of this manuscript. The role of hormonal therapy in the treatment of endometrial cancer has also been studied extensively and will be reviewed as well. A review of the management of endometrial cancers and the histological subtypes at high risk for recurrence will also be performed.
