Endometrial Carcinoma: Contemporary Understanding of Pathogenesis, Risk Factors, and Biological Behaviour in the Era of Molecular Classification
Endometrial carcinoma represents the most prevalent gynaecological malignancy in developed nations, with an alarming global incidence exceeding 400,000 cases annually and a mortality rate that continues to escalate at 1.3% per year. This comprehensive review synthesises contemporary understanding of endometrial carcinoma pathogenesis, examining the complex interplay between hormonal, genetic, and environmental risk factors.
Background: The traditional dualistic classification system has been revolutionised by The Cancer Genome Atlas (TCGA) molecular classification, which identifies four distinct molecular subgroups with unique biological behaviour, prognostic implications, and therapeutic vulnerabilities.
Methods: Critical evaluation of current hypotheses regarding endometrial carcinogenesis, from the established oestrogen-driven pathway to more aggressive variants arising through p53-mediated pathways independent of hormonal stimulation.
Results: Contemporary epidemiological data reveal significant racial and socioeconomic disparities, with obesity emerging as the predominant modifiable risk factor, accounting for approximately 40% of cases through mechanisms involving peripheral aromatisation, insulin resistance, and chronic inflammation.