40. Uterine cancer and premalignant lesions

Endometrial cancer is the most common malignancy of the female genital tract with rising incidence due to increased life expectancy and obesity. Most women presenting with postmenopausal bleeding are diagnosed at an early stage with a favourable outcome. Yet, a significant number of patients have advanced stage disease, or present with recurrent disease, and have limited treatment options. Primary treatment consists of hysterectomy and salpingo-oophorectomy, preferably by a minimal invasive approach. Lymph node dissection is recommended for patients with grade 3 endometrioid, serous and clear cell histology since these patients are at significant risk of extended disease. Adjuvant radiotherapy can improve local control in a subgroup of patients. Chemotherapy is recommended for patients with metastatic disease. Alternatively, hormonal treatment can be effective with less side effects, but development of resistance to hormonal treatment limits the duration of effect. Prevention of (high risk of) endometrial cancer may be accomplished by a healthy lifestyle and improving body weight.