Bakkum-Gamez Jamie N, Gonzalez-Bosquet Jesus, Laack Nadia N, Mariani Andrea, Dowdy Sean C
Division of Gynecologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2008 Jan;83(1):97-112. doi: 10.4065/83.1.97.
Endometrial cancer (EC) remains the most common gynecologic malignancy in the United States. It is expected to become more common as the prevalence of obesity, one of the most common risk factors for EC, increases worldwide. The 2 main histologic subcategories of EC, endometrioid and nonendometrioid EC, show unique molecular aberrations and are responsible for markedly disparate clinical behaviors. The primary treatment of EC is surgery, ie, hysterectomy, removal of the adnexa, and pelvic and para-aortic lymphadenectomy, either via laparotomy or endoscopic techniques. Adjuvant therapy is necessary for patients at high risk of recurrence and consists of vaginal brachytherapy, teletherapy, systemic chemotherapy, or some combination thereof. Multi-institutional trials are in progress in this country and in Europe to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy. Hormonal therapy is an option for some young women with EC who wish to preserve fertility. This review summarizes the diagnosis and management of EC and discusses current controversies and upcoming investigations pertaining to EC staging and adjuvant treatment.
子宫内膜癌（EC）仍是美国最常见的妇科恶性肿瘤。随着肥胖症（EC最常见的危险因素之一）在全球范围内的患病率上升，预计其会变得更加常见。EC的两个主要组织学亚类，即子宫内膜样癌和非子宫内膜样癌，表现出独特的分子异常，并且导致明显不同的临床行为。EC的主要治疗方法是手术，即通过剖腹手术或内镜技术进行子宫切除术、附件切除术以及盆腔和腹主动脉旁淋巴结切除术。对于复发风险高的患者，辅助治疗是必要的，包括阴道近距离放射治疗、远距离放射治疗、全身化疗或它们的某种联合。美国和欧洲正在进行多机构试验，以更好地确定针对不同患者亚组的最佳辅助治疗方法，以及手术分期在减少放疗过度使用和使用不足方面的作用。激素治疗是一些希望保留生育能力的年轻EC患者的一种选择。本综述总结了EC的诊断和管理，并讨论了与EC分期和辅助治疗相关的当前争议和即将开展的研究。
