Endometrial adenocarcinoma is the most common gynecological malignancy in industrialized coun- tries. However, incidences vary among regions. In industrialized countries the incidence maybe four to six times higher than in low-resourced countries. A number of reasons may explain this discrepancy.
For the Seventh Edition of this text, the title has been changed to Kistner's Gynecology
and Women's Health (from Kistner's Gynecology) to recognize the broad scope and
expanded interest in the field of women's health care. Although over the past 35 years,
previous editions of Kistner have appealed largely to students, trainees, and
practitioners in gynecology, this new edition should be useful not only for gynecologists
but for internists, family practitioners, and women's health specialists who are devoting
more of their time and effort to women's medical issues.
Leiomyomas are discrete, rounded, firm, white to pale pink, benign myometrial tumors composed mostly of smooth muscle with varying amounts of fibrous connective tissue. Approximately 95% arise from the uterine corpus and 5% from the cervix. Only occasionally do they arise from a fallopian tube or round ligament. Leiomyomas are the most frequent pelvic tumors, occurring in 25% of white and 50% of black women by age 50 years. Leiomyomas account for 10% of gynecologic problems and have their peak incidence in the fifth decade.
The main uterine artery and its branches are derivatives of the hypogastric artery. At the level of the internal cervical os, the uterine artery bifurcates into the cervical and corporal branches. At the uterotubal junction, the corporal branch turns laterally and upward toward the ovary where it establish anastomoses with the ovarian artery, forming an arterial arcade that provides perfusion to the upper aspect of the uterine corpus.
Incidence and Epidemiology
Carcinoma of the endometrium is the most common female pelvic malignancy. Approximately 39,080 new cases are diagnosed yearly, although in most (75%), tumor is confined to the uterine corpus at diagnosis, and therefore most can be cured. The 7400 deaths yearly make uterine cancer only the eighth leading cause of cancer death in females.
The period of conﬁnement during birth and 6 weeks after. During this time, the reproductive tract returns anatomically to a normal nonpregnant state. Uterine Changes INVOLUTION OF THE UTERINE CORPUS Immediately after delivery, the fundus of the contracted uterus is slightly below the umbilicus. After the ﬁrst 2 days postpartum, the uterus begins to shrink in size.
The growing tissue then begins
to release more hormones to keep everything in the right condition. How-
ever, if fertilization does not occur, the continued preparations in the
uterus are unnecessary. The body realizes this near the end of the four-
week period of the menstrual cycle. At this time, the level of LH decreases,
the corpus luteum breaks down, and the level of progesterone decreases.
Without this hormone, the uterine lining no longer remains intact.
Instead, the lining breaks down.