Endometrial Cancer

Lifestyle factors contribute appreciably to endometrial cancer risk, with obesity accounting for over one-third of incident cases in high-income societies. Unlike cervical cancer, which is a model of viral carcinogenesis, endometrial cancer is considered a model of hormonal carcinogenesis, as use of unopposed estrogens postmenopausally and obesity are the best-established risk factors. Endometrial cancer is also the only known malignancy for which cigarette smoking has been shown to confer protection. Risk reduction conferred by current smoking, past oral contraceptive use, childbearing, and physical activity is believed to be mediated by hormones. This may also apply to the increase in risk associated with obesity, which increases peripheral production of estrogens, and with diabetes mellitus. Hence, it should be possible to prevent a substantial fraction of endometrial cancers through lifestyle modification. Pathological classification of endometrial cancer is currently evolving and studies are revealing different molecular subtypes within the same histological groups.