Endometrial cancer: rising incidence detection and treatment.

This editorial consists of summaries of the discussions on incidence pathogenesis prognosis and patient follow-up and transcripts of the discussions on detection and treatment of endometrial carcinoma from a symposium held in Carefree Arizona. 75% of the cancers occur in postmenopausal women; average age is 52 years but is decreasing. Endometrial carcinoma rose from 20.3 to 46.3% of all uterine cancers in Cleveland University Hospitals from 1941-1970. Older patients are often diabetic overweight nulliparous with anovulatory or familial history; young women frequently resemble mild Stein-Levinthal syndrome. Clinically 20% of patients are assymptomatic others may have softer or larger uterus larger ovaries irregular postmenopausal bleeding or lengthy onset of menopause. The Gravlee jet wash is indicated for high risk patients and those about to take estrogen. Endometrial carcinoma first affects epithelium then endometrial stroma then upper myometrium lower myometrium then other organs perhaps via lymphatics vagina tubes but ascites is uncommon. Generally U.S. physicians use intrauterine radium followed by surgery British use surgery first and Swedish use radiation only. Cases must be treated individually e.g. surgery only for minimal cancer radium and surgery for more serious cases and preoperative external radiation also for advanced disease. Although radiation lessens chance of implantation during surgical trauma insertion of intrauterine radium enhances spread of tumor cells. Injectable progestins sometimes control metastatic disease although they require 8 weeks to act. Progestins may help those with late recurrence squamous metaplasia or who are under 50 years of age. Estrogens are rarely effective. Prognois for terminal patients often includes subjective improvement bowel obstruction lung complications hemorrhage. Radiation side effects and menopausal symptoms are often problems for cured patients. In young cured patients the endometrium should be suppressed with progestins or oral contraceptives.