CA: A Cancer Journal for Clinicians, Vol 30, 16-22, Copyright
© 1980 by American Cancer Society
An Approach to the Control of Carcinoma of the Endometrium
S. B. Gusberg M.D., D.SC.1
1 Professor and Chairman, Department of Obstetrics and Gynecology, The Mount Sinai School of Medicine of the City University of New York; and President, American Cancer Society, New York, New York.
There are still problems to be solved regarding the most efficient approach to the diagnosis and treatment of carcinoma of the endometrium, but we have every right to expect that with the recognition of women at high risk we can reduce this disease to a minimum and possibly eradicate mortality from it to a very high degree. The approach to this state of control depends upon the following factors:
1. recognition of adenomatous hyperplasia and carcinoma in situ of the endometrium as true precursors of invasive endometrial cancer;
2. recognition of the high risk menopausal patient, through a histologic sampling of patients at the menopause with or without dysfunctional bleeding;
3. further research into the technology of obtaining histologic samples in all menopausal women on an ambulatory basis without anesthesia as a means of screening for the precursors of endometrial cancer;
4. adoption of the staging formula that will allow us to understand on a clinical basis the order of virulence of any endometrial cancer that comes to treatment so that we may not overtreat the patient with a less aggressive tumor and thereby penalize her with an excess of complications or, on the other hand, undertreat the patient with a highly virulent tumor and penalize her by a lower rate of cure than might be obtained by more radical treatment;
5. the appropriate recognition of the place of surgical and radiotherapeutic treatment and combinations thereof that are most appropriate for the treatment of the individual patient;
6. recognition of the menopause as the time of life when high risk patients may be identified; and
7. caution in hormonal treatment in the perimenopausal or postmenopausal era until evidence of their efficacy supercedes evidence of their possible etiologic role in endometrial aberration.
When these criteria are fulfilled there is little doubt that we will be able to control cancer of the endometrium in somewhat the same way that we are beginning to control cervical cancer.
