CA: A Cancer Journal for Clinicians, Vol 36, 245-253, Copyright
© 1986 by American Cancer Society
Current Concepts in the Control of Carcinoma of the Endometrium
S. B. Gusberg M.D., D.Sc.1
1 Distinguished Service Professor in the Department of Obstetrics and Gynecology at Mount Sinai School of Medicine, and Special Consultant to Medical Affairs and Research for the American Cancer Society, in New York, New York.
With respect to the most efficient approach to the diagnosis and treatment of carcinoma of the endometrium, the recognition of women at high risk can reduce this disease to a minimum and possibly eradicate much of the resulting mortality. Such an approach depends on the following factors:
• Recognition of the menopause as a time of life when high-risk patients may be identified.
• Recognition of adenomatous hyperplasia as a precursor of invasive endometrial cancer.
• Further research into the technology of obtaining suitable samples in menopausal women on an ambulatory basis without anesthesia is indicated as a search for efficient screening. Until such research yields new methods, however, recognition of the high-risk menopausal women through histologic sampling at menopause, with or without dysfunctional bleeding, can serve well.
• The modern FIGO staging formula shows the order of clinical virulence of any endometrial cancer and allows individualization of treatment in a manner that prevents overtreatment of those with less aggressive tumors and undertreatment of those with highly virulent tumors. Overtreatment causes an excess of complications, and undertreatment leads to a lower rate of cure than might be obtained by more radical treatment.
• Such individualization of treatment allows recognition of the appropriate place for surgical and/or radiotherapeutic treatment and the combinations that are most appropriate for the particular patient. Individualization also encourages the development of new chemotherapeutic agents and more efficient use of those now existing.
• Hormonal treatment is indicated for several categories of perimenopausal or postmenopausal patients. The insights of modern steroid metabolic technology enable us to establish a benefit-risk ratio that can offer our patients the most advanced treatment based on scientific evidence.
With these criteria in mind, we can begin to control cancer of the endometrium in much the same way that we have begun to control cancer of the cervix.
