• Worldwide: In 2022, there were an estimated 420,368 new cases of cancer of the corpus uteri, with an age-standardized incidence of 8.4 per 100,000 women. It was the 15th most common cancer overall globally. IARC GLOBOCAN 2022 data
• Geographic pattern: Rates are highest in North America, Europe, and Australia/New Zealand, and lower in many parts of Africa and South-Central Asia.
• Age: Incidence rises with age. Diagnosis commonly occurs around age 60 and is uncommon before age 45. - Goldman-Cecil Medicine International Edition, p. section 184
• Trend: Incidence is increasing, largely associated with population ageing and higher prevalence of obesity, diabetes, and prolonged estrogen exposure. - Goldman-Cecil Medicine International Edition, p. section 184
• United States: The textbook estimates about 67,000 new cases annually, and a lifetime risk near 3% for women in the US. - Goldman-Cecil Medicine International Edition, p. section 184

Etiology of uterine cancer

Major etiologic and risk factors

1. Unopposed estrogen exposure
   • Estrogen-only menopausal hormone therapy in a woman with an intact uterus
   • Chronic anovulation, especially in polycystic ovary syndrome (PCOS)
   • Obesity, because adipose tissue converts androgens into estrogen
   • Estrogen-secreting ovarian tumors, which are uncommon
2. Obesity and metabolic factors
   • Obesity is a major modifiable risk factor.
   • Type 2 diabetes, metabolic syndrome, and physical inactivity are associated with higher risk, partly through insulin resistance and increased estrogen availability.
3. Reproductive history associated with longer lifetime estrogen exposure
   • Early menarche
   • Late menopause
   • Nulliparity, meaning no prior pregnancy
   • Infertility or chronic anovulation
4. Endometrial hyperplasia
   • Especially atypical hyperplasia / endometrial intraepithelial neoplasia (EIN), a precancerous lesion. It has a strong association with later endometrial carcinoma.
5. Drugs
   • Tamoxifen, used for breast cancer, has estrogen-like activity in the endometrium and increases risk.
   • Estrogen therapy without progestogen is causally linked to endometrial cancer in women with a uterus.
6. Genetic predisposition
   • Lynch syndrome is the most important inherited cause and results from pathogenic variants in DNA mismatch-repair genes, such as MLH1, MSH2, MSH6, and PMS2.
   • Cowden syndrome due to PTEN alterations also raises risk.
   • A first-degree family history of endometrial cancer increases risk.
7. Age
   • Risk rises with age and most cases occur after menopause.

Two broad pathogenetic patterns

• Endometrioid tumors: the commoner pattern, usually estrogen-related and often developing through hyperplasia/EIN. Common molecular changes include PTEN, PIK3CA, ARID1A, and mismatch-repair abnormalities.
• Non-endometrioid tumors such as serous carcinoma: less dependent on estrogen; often occur in older women with an atrophic endometrium and frequently have TP53 abnormalities.

Etiology of endometrial (uterine) cancer

• Obesity
• Chronic anovulation, especially polycystic ovary syndrome
• Estrogen-only hormone replacement therapy
• Early menarche and late menopause
• Nulliparity
• Endometrial hyperplasia, especially atypical hyperplasia/EIN
• Tamoxifen use
• Diabetes mellitus and metabolic syndrome
• Increasing age
• Lynch syndrome
• Cowden syndrome/PTEN mutation
• Family history of endometrial cancer

1. Stage I: Cancer is confined to the uterus.
2. Stage II: Cancer has spread to the cervical stroma but remains within the uterus.
3. Stage III: Cancer has spread outside the uterus to nearby pelvic tissues, vagina, ovaries/fallopian tubes, lymph nodes, or pelvic/peritoneal surfaces.
4. Stage IV: Cancer has invaded the bladder or bowel lining, spread within the abdomen beyond the pelvis, or metastasized to distant organs such as lung, liver, bone, or brain.

• Globally: about 1.2 million cases occur each year.
• High-income/developed countries: approximately 0.5 to 1.5 cases per 100,000 adults per year, reduced substantially by Hib, pneumococcal, and meningococcal vaccines.
• African meningitis belt: incidence is much higher during epidemics. In 2025, 24 countries in this region reported 21,526 suspected cases. WHO meningitis update

Comparison of meningitis incidence

Nursing diagnoses for a patient with meningitis

1. Hyperthermia related to infectious process, as evidenced by fever and chills.
2. Acute pain related to meningeal inflammation and increased intracranial pressure, as evidenced by severe headache, neck stiffness, and photophobia.
3. Risk for ineffective cerebral tissue perfusion related to cerebral edema and increased intracranial pressure.
4. Acute confusion related to central nervous system infection, fever, and altered cerebral function.
5. Risk for injury related to seizures, altered consciousness, weakness, and impaired coordination.
6. Risk for aspiration related to decreased level of consciousness, vomiting, or seizures.
7. Deficient fluid volume related to fever, sweating, vomiting, poor oral intake, and fluid restriction if prescribed.
8. Imbalanced nutrition: less than body requirements related to anorexia, nausea, vomiting, and acute illness.
9. Disturbed sensory perception related to meningeal irritation, evidenced by photophobia and sensitivity to sound.
10. Anxiety related to acute illness, isolation, unfamiliar environment, and fear of complications.
11. Deficient knowledge related to disease process, treatment, medication adherence, prevention, and warning signs.
12. Risk for transmission of infection related to a suspected or confirmed transmissible cause, particularly meningococcal or Hib meningitis. Droplet precautions are used for suspected or confirmed meningococcal or Hib meningitis until 24 hours after effective antimicrobial therapy. CDC isolation guidance