Malignant Tumors of the Uterus

Abstract

Malignant uterine tumors are responsible for up to 9% of all new cancer cases and for 4.5% of all cancer related deaths in women. The three important uterine cancers are endometrial cancers, uterine sarcomas and cervical cancers. Endometrial cancers are typically found in elderly women and are > 70% hormone sensitive (type I), type II is often less differentiated and not hormone sensitive. Diagnosis can be achieved by vaginal ultrasound and by histology after hysteroscopy and curettage of the uterine cavity. Therapy of choice is the stage related radical hysterectomy (incl. lymphnode dissection). Postoperatively and at progressive stages endocrine and radiation therapies can be useful. Chemotherapy is only useful in not hormone sensitive and in progressive tumors. Uterine sarcomas are a rare and heterogeneous group of tumors. Therefore no clinical guidelines are available for this entity. These often aggressive tumors are hardly responding to systemic and radiation therapy. Therefore radical tumor surgery plays the main therapeutic role. Cervical carcinomas are usually growing on an underlying chronic infection with oncogenic HPV subtypes. Important co-factors for carcinogenesis are tobacco smoking, an immunodeficiency and chronic genital infections of other causes. Cervical carcinomas and their precursor lesions are easily accessible for screening tests. Many tumors are detected in early tumor stages. Preoperatively diagnostic procedures are performed to examine local and distant tumor growth. In early stages a radical hysterectomy (incl. pelvine (+paraaortal) lymphonodectomy) and in rare cases an uterus preserving surgery should be performed. Alternatively a primary radiochemotherapy can be applied. Patients with tumors in stages > or = FIGO IIb receive a primary combined radiochemotherapy.