Introduction
No conclusive, prospective randomized trials clearly offer definitive guidelines.
Many questions remain
When is lymph node sampling helpful?
What is the value of postoperative radiation?
What is the value of adjunctive chemotherapy?
What is the role of hormone therapy?
Which chemotherapeutic agents are active?
Epidemiology And Risk
Incidence: 2006 American Cancer Society projections
Most common gynecologic cancer (after breast)
Third: colorectal (66,000)
Fourth: endometrial (4,000)
B. Distribution by stage: International Federation of Gynecology and Obstetrics
Stage I: 75%
Stage II: 15%
Stage III: 7%
Stage IV: 3%
Estimate of risk
Geographic: the white population in the United States has the highest age-adjusted incidence in the world
Race: United States
White peak: 87% in 100,000 at 65-70 years
Black peak: 78 % in 100,000 at 75-80 years
3. Age
Postmenopausal: 75-80%
Mean age at diagnosis: 61 years
<5 % below age 40
4. Obesity
From 20-50 lbs overweight: 3X
Over 50 lbs overweight: 9X
Diabetes: up to 3X increased risk
Hypertension
Parity
One-third nulliparous
Risk decreases with