Uterine cancer

Uterine cancers are the most common female genital cancer in the developed world and the fourth most common malignancy in women. In South Africa and most developing countries it is the second most common genital tract malignancy after cervical carcinoma. While the incidence of uterine cancers is marginally higher in developed countries (5.9 vs 4 per 100,000), the disease-specific mortality rate is higher in developing countries. Uterine cancers include tumours that develop in the endometrium (carcinomas), the endometrial support cells (endometrial stromal sarcomas), and the myometrium (sarcomas). Endometrial carcinomas represent over 90% of uterine cancers, the incidence of which is increasing and is most likely driven by longer life expectancy, obesity, and a sedentary lifestyle. Most endometrial carcinomas present in postmenopausal women; however, in women with significant risk factors (such as unopposed endogenous oestrogen production as occurs in women with polycystic ovarian syndrome) or a genetic predisposition such as hereditary non-polyposis colorectal cancer (HNPCC)/Lynch 2 syndrome, tumours may present before the age of 40 years. Sarcomas constitute less than 10% of uterine cancers, the majority of which are leiomyosarcomas. Only 2% of uterine sarcomas originate in the endometrial stromal tissue. Most sarcomas present between the age of 40 and 60 years. For the purpose of this chapter, endometrial carcinomas and sarcomas will be discussed separately.