Although the contemporary management of endometrial cancer is straightforward in many ways, novel data has emerged over the past decade that has altered the clinical standards of care while generating new controversies that will require further investigation. Fortunately most cases are diagnosed at early stages, but high-risk histologies and poorly differentiated tumors have high metastatic potential with a significantly worse prognosis. Initial management typically requires surgery, but the role and extent of lymphadenectomy are debated especially with well-differentiated tumors. With the changes in surgical staging, prognosis correlates more closely with stage, and the importance of cytology has been questioned and is under evaluation. The roles of radiation in intermediate-risk patients and chemotherapy in high-risk patients are emerging. The therapeutic index of brachytherapy needs to be considered, and the best sequencing of combined modalities needs to balance efficacy and toxicities. Additionally novel targeted therapies show promise, and further studies are needed to determine the appropriate use of these new agents. Management of endometrial cancer will continue to evolve as clinical trials continue to answer unsolved clinical questions. 1. Epidemiology of Endometrial Cancer Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women, comprising 6% of female cancers. Only breast, lung, and colon cancers have higher incidence rates. The American Cancer Society estimated that there were 47,130 new cases of endometrial cancer and 8,010 deaths from endometrial cancer in 2012 [1]. Based on 2004–2008 Surveillance Epidemiology and End Results (SEER) data on endometrial cancer, the age-adjusted incidence rate is 23.9 per 100,000 women per year, and the age-adjusted death rate is 4.2 per 100,000 per year [2]. In the United States, the lifetime risk of developing endometrial cancer is 3%. Excluding women who have had a hysterectomy, 6% of women are diagnosed with endometrial cancer in their lifetime [3, 4]. Rising life expectancy and increasing rates and severity of obesity have contributed to the increasing incidence of endometrial cancer [5]. The National Health and Nutrition Examination Survey (NHANES) in 2009-2010 reported that 36% of adult females in the United States are obese [6]. While the absolute number of estimated new cases of endometrial cancer each year is similar between developed and developing countries, it occurs in a higher percentage of the population in developed
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