Endometrial cancer is the most common cancer that you will see in your gynecologic practice. It is the most common malignancy that we see in the pelvis and it’s only second to breast cancer. It’s estimated that there will be between 30,000 to 40,000 cases in the new millennium diagnosed of endometrial cancer in the United States. If you are unfortunately enough to get a female cancer, endometrial cancer tends to be one of the friendlier cancers, although it has the highest incidence of malignancy in the female pelvis, it also has one of the lowest death rates due to it’s early detection rate which hopefully, as the talk goes on, we will understand why endometrial cancer, almost 75 to 85% of the time is picked up as stage I disease, where the other malignancies frequently are picked up as an advanced stage and therefore do not have the curable rate that endometrial cancer has. The median age of endometrial cancer is 61, the vast majority of cases occur between the ages of 50 and 59, this makes endometrial cancer a very easily detectable cancer because the vast majority of your women are postmenopausal. Indeed, 75% of patient’s diagnosed with endometrial cancer are post menopausal therefore they walk in with a big red flag saying I am having postmenopausal bleeding and this usually incites a very thorough workup and therefore early detection of the malignancy.
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Approximately 25% of women who are diagnosed with endometrial cancer unfortunately are not postmenopausal, and this group of patient’s is more difficult to diagnose, you really must listen to the patient’s history saying I am having increased menstrual bleeding during the month or I’m having heavier bleeding than I used to have and it takes an astute physician to say we really need to pursue this and get an endometrial biopsy. Approximately 5% of patient’s who develop endometrial cancer are below the age of 40, and again, this is even a more difficult group to diagnose. Of the group that is diagnosed before the age of 40, most of these patient’s are morbidly obese and have polycystic ovarian syndrome, so they do come walking in the door with a very enormous risk factor, you see this morbidly obese patient and you obtain a menstrual history, and say, maybe I ought to get a quick papular endometrial biopsy just to confirm that nothing further is going on.