Management of Endometrial Cancer Precursors in Obese Women

Abstract

Endometrial cancer can generally be divided into two clinical subtypes, designated as type I and type II disease, each with different risk factors, histology, genetics, treatment and prognosis. Type I endometrial cancer, or low grade endometrioid adenocarcinoma, accounts for 80–90% of new cases of endometrial cancer. Endometrioid endometrial cancer is strongly associated with unopposed estrogen exposure (such as hormone replacement therapy) and obesity. Type II endometrial cancers, including clear cell carcinoma and uterine papillary serous carcinoma, are relatively rare. While the etiology of these rare tumors is not well understood, type II endometrial cancers are not associated with obesity. As such, this chapter will focus on low grade endometrioid (type I) endometrial cancer and its precursor lesions. Due to the close connection between obesity and endometrioid endometrial cancer, obese women are at increased risk for precancerous lesions and low grade endometrial cancers, and consideration is warranted for management of these conditions in the obese population.