DR - Su LeiEndometrial Cancer

Endometrial Cancer
9.2.2023
Introduction
• Usually arises in postmenopausal women

• Incidence continues to increase in many developed
countries and it is now the most common
gynaecological cancer in UK.
• 75% of women present with stage I disease and for
most of them the management is surgical and
prognosis is good.
Incidence
• Endometrial cancer is the fourth most common

cancer in women in the UK.
• Occurs in the age group 60-79 years
• Incidence increases between the ages of 40 and 55,
thereafter reaching a plateu.
• Rare in women before the age of 40, less than 2 per
100000 women.
Aetiology
• Women with high levels of circulating oestrogens or

prolonged oestrogen influence are recognized high risk
group.
• Endometrial cancer is seen in the following situations
- obesity, associated with co-morbidity such as
diabetes and hypertension
- tamoxifen therapy
- oestrogen therapy unopposed by progestogen
- polycystics ovarian syndrome (PCOS)
- early menarche and late menopause
Pathology
• Endometrioid carcinoma contributed about 90% of

tumours
• Other histotypes are found and their importance often
lies in their worse prognosis.
• Papillary serous,clear cell carcinoma and
carcinosarcoma are all associated with higher rates of
metastasis and are also resistant to conventional
therapy.
• In addition to histotype, there are other pathological
features for importance of endometrial cancer.
• These include the degree of differentiation and
myomerial infiltration.
Histopathology by WHO/ International
Society of Gynaecological Pathology
Classification
• Endometriod carcinoma
• Adenocarcinoma
• Adenocanthoma (adenocarcinoma with squamous
metaplasia)
• Adenosquamous carcinoma (mixed adenocarcinoma
and squamous cell carcinoma)
• Mucinous adenocarcinoma
• Papillary serous adenocarcinoma
• Clear cell carcinoma
• Undifferentiated carcinoma
• Mixed carcinoma
Grading of tumour differentiation
G1 5% or less of a non-squamous or non-morular

solid growth pattern
G2 6-50% of a non-squamous or non-morular

solid growth pattern
G3 50% of a non-squamous or non-morular solid

growth pattern
Presentation and diagnosis
• Usually presents with postmenopausal bleeding

• Sometimes presents with perimenopausal bleeding
Investigation of postmenopausal bleeding
• Transvaginal ultrasound (TVS) to detect endometrial

thickeness and to exclude endometial pathology
• Gold standard is hysteroscopy and hysteroscopic
directed biopsy
• Others - endometrial sampling by Pipelle, MVA as
out-patient
Staging
• The staging of endometrial cancer is
surgicopathological.
• Tumour grade and depth of myometrial involvement
are main determinants of extrauterine spread.
• Metastatic spread occurs characteristically to pelvic
and para-aortic lymph nodes.
• Distant metastasis is uncommon at presentation.
• The most common site of distant metastasis are
vagina and lungs, but the inguinal and
supraclavicular lympn nodes, liver and brain may
also be involved.
FIGO 2018 Staging
Endometrial cancer imaging
• MRI is the imaging method of choice for

pretreatment staging to assess myometrial invasion,
cervical invovlement and lymph node status.
Management
• Women with disease localized to the corpus are
usually curable by surgery.
• In high risk groups, adjuvant therapy is employed.
• High risk groups – deep myometrial invasion and
grade 3 tumours including papillary serous
histological types
• High risk groups are associated with a poorer
prognosis because of increased risk of nodal disease
and recurrence.
• Women with endometrial cancer are often elderly
with other medical problems, and pre-operative
assessment for fitness for an anaesthetic and surgery
is essential.
• Survival rates are reduced by 20% when primary
surgery is not fasible.
Early stage disease
• Treatment of choice is total abdominal hysterectomy

and bilateral salpingo-oopherectomy (TAH+BSO)
• Stage II disease should be treated the same as stage I
disease by TAH+BSO.
• Where there is cervical stromal involvement, the
treatment options are radical hysterectomy with
pelvic lymphadenectomy or TAH+BSO with or
without lymphadenectomy followed by post-
operative radiotherapy.
Advanced stage disease
• At presentation, only 13% of women have stage III

disease and 3% stage IV disease.
• Stage III disease - treated with surgery and radiotion
or radiotherapy alone
• Stage IV disease - chemotherapy (most effective
agents are cisplatin and doxorubicin) is usually
offered first
Prognosis
• Survival is related to stage of presentation and grade
of tumour.
Stage 5-year survival (%)

Stage I 80
Stage II 65
Stage III 30
Stage IV 10
Thank You!

DR - Su LeiEndometrial Cancer

Uploaded by

Copyright:

Available Formats

DR - Su LeiEndometrial Cancer

Uploaded by

Document Information

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

DR - Su LeiEndometrial Cancer

Uploaded by

Copyright:

Available Formats

Endometrial Cancer

• Usually arises in postmenopausal women

• Endometrial cancer is the fourth most common

• Women with high levels of circulating oestrogens or

• Endometrioid carcinoma contributed about 90% of

G1 5% or less of a non-squamous or non-morular

G2 6-50% of a non-squamous or non-morular

G3 50% of a non-squamous or non-morular solid

• Usually presents with postmenopausal bleeding

• Transvaginal ultrasound (TVS) to detect endometrial

• MRI is the imaging method of choice for

• Treatment of choice is total abdominal hysterectomy

• At presentation, only 13% of women have stage III

Stage 5-year survival (%)

You might also like