Endometrial Carcinoma

Benign and malignant condition of the uterus
Endometrial adenocarcinoma is the most common genital cancer and the

fourth most common cancer in women. The incidence is rising due to
longevity.
Precancers are initiated by mitogenic stimulus of unopposed estrogen
Some premalignant clones involute, others progress by additional mutation
and selection, eventually reaching a stage where hormonal support is no
longer required for growth.
Endometrial hyperplasia
SIMPLE HYPERPLASIA
Increase in glands (irregular and cystic) and stroma
Rarely progress to carcinoma
COMPLEX HYPERPLASIA
Glandular crowding and branching with a complex growth pattern
Less than 5% progress to carcinoma
ATYPICAL HYPERPLASIA
Histopathology- architectural complexity combined with atypical nuclear
features
Irregular epithelial lining--tufting, stratification, scalloping
Cytomegaly, loss of polarity, increased nuclear to cytoplasmic ratio
hyperchromatism, prominence of nucleoli.
Approximately 25% progress to carcinoma
Risk of Endometrial Cancer
Management of endometrial hyperplasia
This Depends On
Age
Type of hyperplasia
Need for children
Desire of the patient
Lines Of Treatment
COC
Progestin
Hysterectomy
Estrogen and Uterine Cancer

Estrogen can stimulate the division of uterine cells that already have DNA
mutations, and it also increases the chances of developing new mutations.
Whether the mutations are inherited or spontaneous, estrogen-driven
proliferation will increase the number of these altered cells that can
ultimately lead to cancer.
Hyperestrogenism of obese
Risk factors for corpus cancer
Estrogen exposure; nulliparity, late menopause, PCOS, FOT, tamoxifen,
ERT sequential pills.
Systemic diseases; diabetes mellitus, hypertension, obesity. hypothyroidism.
Previous pelvic irradiation.
Others; Lynch II families, family history of cancer breast, ovary or colon.
Endometrial tumorigenesis
Endometrial precancers have been usually diagnosed as atypical endometrial
hyperplasias or endometrial Intraepithelial Neoplasia (EIN).
Precancers are the targets of, and effectors for, hormonally mediated tumor
risk.
Screening for endometrial cancer
Screening Of Risky Patients
1. Pap smear
2. Endometrial lavage
3. Endometrial thickness (TVS)
4. Doppler flow study
5. Office biopsy
Early detection of endometrial cancer
Pap smears detect as few as 50 percent of cases and it's not noticeable during
a pelvic exam.
The first clue is vaginal bleeding. An endometrial biopsy can be performed.
This is an office procedure where the doctor removes a small piece of tissue
from the uterine lining for analysis.
For a more accurate diagnosis, a dilation and curettage can be performed.
This procedure usually requires some form of anesthesia and is done in a
hospital.
Pathology of Corpus cancer
1. Adenocarcinoma
2. Endometroid carcinoma
3. Adenoacanthoma
4. Serous carcinoma
5. Mucinous carcinoma
6. Papillary carcinoma
7. Clear cell carcinoma
8. Squamous carcinoma
9. Mixed cancer
10. Metastatic cancer
11. Sarcoma
Manifestation of endometrial cancer
1. Asymptomatic
a. Endometrial cell in Pap smear
b. Endometrial cancer in curettage sample
c. Endometrial cancer in hysterectomy specimen
2. Post menopausal bleeding
3. Irregular uterine bleeding
4. Leukorrhea
5. Pyometra
6. Manifestation of distant spread
PMB
HRT
Senile vaginitis
Senile endometritis
Fibroid
Corporal polyp
Cervical polyp
Urethral caruncles
Endometrial cancer
Cervical cancer
Ovarian cancer
Vaginal cancer
Diagnosis of endometrial cancer

Clinical manifestations
Endometrial thickness (TVS): > 3mm in postmenopausal women & >
5mm in postmenopausal women under HRT.
Doppler flow study
Office biopsy
Adenocarcinoma of the endometrium

FIGO surgical staging
Choice of treatment in corpus cancer
DEPENDS UPON
Staging
Grading
Papillary cancer
Myometrial invasion
Nodal spread
Peritoneal cytology
LINES OF TREATMENT
a. Simple hysterectomy with BSO
b. Extended hysterectomy
c. Radical hysterectomy
d. Lymphadenectomy
e. Radiotherapy
i. Intracavitary
ii. External
f. Progestogens
Contraindication to radiotherapy
1. Abdominal mass
2. Adnexal mass
3. Diverticulitis
4. Pelvic sepsis
5. Pelvic kidney
6. Pyometra
7. Ascites
Postoperative Treatment
Grade 1 and stage Ia or Ib
No further treatment
Grade 2 and stage Ia or Ib
Vault irradiation
Grade 3 and stage > Ib
Pelvic irradiation
Recurrence
Radiotherapy
Chemotherapy (DMPA)
Inadvertent discovery of endometrial cancer in hysterectomy specimen

Evaluate the patient general condition
Examine the hysterectomy specimen
Allow the patient to share in decision
Examination of hysterectomy specimen
Adnexal involvement
Cervical extension
Myometrial invasion
Size of the growth
Histology of the growth
Tumor grading
The vault is included in the specimen
Recurrence after surgery

Vaginal recurrence
Vault (lymphatic extension)
Lower vagina (venous emboli)
Pelvic recurrence
Distant recurrence
Risk of recurrence in early stage disease
1. High tumor grade

2. Papillary cancer
3. Deep myometrial invasion
4. Positive pelvic nodes
5. Clear cell, papillary serous, squamous or undifferentiated histologies
6. Occult adnexal involvement
7. Occult cervical extension
8. Occult vault extension
9. Positive peritoneal cytology
Prognosis
Grade, stage and survival
Stromal sarcoma
Low Grade Stromal Sarcoma (endolymphatic stromal myosis)
Well differentiated stromal cells infiltrating the myometrium and
lymphatic channels
15% of cases result in distant metastases and death
High Grade Stromal Sarcoma
Sarcoma comprised of markedly atypical stromal cells having
numerous mitoses and with infiltrate indistinct margins
50% of cases result in distant metastases and death
Stromal sarcoma
Mixed Mesodermal Tumours
Contain heterologous mesenchymal elements.
In adults: large fleshy mass protruding into the uterine cavity.
Metastasis via blood stream is common
Local recurrence after removal
Poor prognosis
In Infants & young girls: Sarcoma Botryoides or Rhabdomyosarcoma
presented with blood stained watery vaginal discharge. The vagina
contains grape – like masses of soft growth.Local recurrence & blood
metastasis are common.
Stromal sarcoma
Leiomyosarcoma
Arise in the uterine muscles
Rarel arise by transformation of a benign fibromyoma { 0.2% of
fibroids }
Occasionally arise as endometrial stromal sarcoma.
Distant metastasis via blood stream and direct spread to adjacent
organs often occurred.
Rapid growth of the tumours, uterine bleeding with increasing pain .
In many cases the diagnosis is made after its removal.
Stromal sarcoma
TREATMENT
TAH with BSO
Followed by external RADIOTHERAPY
The prognosis is poor except for leiomyosarcoma arising in a
fibromyoma.
In children: Modern use of combination of External Radiotherapy
and Chemotherapy allowed less radical surgical approach. Pelvic
Exentration is rarely indicated now .

Endometrial Carcinoma

Uploaded by

Copyright:

Available Formats

Endometrial Carcinoma

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Endometrial Carcinoma

Uploaded by

Copyright:

Available Formats

Benign and malignant condition of the uterus

Endometrial adenocarcinoma is the most common genital cancer and the

Estrogen and Uterine Cancer

Diagnosis of endometrial cancer

Adenocarcinoma of the endometrium

Inadvertent discovery of endometrial cancer in hysterectomy specimen

Recurrence after surgery

1. High tumor grade

You might also like