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Endometrial Cancer

Endometrial Cancer

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Endometrial Cancer

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  1. Endometrial Cancer District 1 ACOG Medical Student Teaching Module 2009

  2. Symptoms • Post menopausal bleeding • Endometrial cells on Pap • Perimenopausal with irregular heavy menses, increasingly heavy menses • Premenopausal with abnormal uterine bleeding with history of anovulation

  3. Differential Diagnosis for PMB • Exogenous estrogen use- ie tamoxifen • Atrophic endometritis/vaginitis • Endometrial/cervical polyps • Endometrial hyperplasia • Endometrial Cancer • Other gynecologic cancers

  4. Risk factors for Endometrial Cancer • Increased estrogen • Hormone therapy • Obesity • Anovulation/PCOS • Estrogen secreting tumors • Older age • Infertility • Early menarche • Late menopause • Genetics • HNPCC • Caucasian

  5. Preoperative Work-up • Endometrial biopsy • Ultrasound • For suspected advanced stage may need: • Cystoscopy • Sigmoidoscopy • Pelvic and Abdominal CT • Labs • CBC • Chem 7 • Liver function tests • EKG, CXR

  6. Endometrial Hyperplasia (EIN) • Precursor to endometrial cancer • Risk of progression related to cytologic atypia • Presents with abnormal bleeding • Simple • Benign irregular dilated glands • No atypia: 1% progress • Atypia: 8% progress • Complex • Proliferation of glands with irregular outlines, back to back crowding of glands, but no atypia • No atypia: 3% progress • Atypia: 29% progress

  7. Staging of Endometrial Cancer • I: Confined to uterine corpus • IA: limited to endometrium • IB: invades less than ½ of myometrium • IC: invades more than ½ of myometrium

  8. Staging of Endometrial Cancer • II: invades cervix but not beyond uterus • IIA: endocervical gland involvement only • IIB: cervical stroma involvement

  9. Staging of Endometrial Cancer • III: local and/or regional spread • IIIA: invades serosa/adnexa, or positive cytology • IIIB: vaginal metastasis • IIIC: metastasis to pelvic or para-aortic lymph nodes

  10. Staging of Endometrial Cancer • IVA: invades bladder/bowel mucosa • IVB: distant metastasis

  11. Five Year Survival • Stage I: 81-91% • 72% diagnosed at this stage • Stage II: 71-78% • Stage III: 52-60% • Stage IV: 14-17% • 3% diagnosed at this stage

  12. Spread Patterns • Direct extension • most common • Transtubal • Lymphatic • Pelvic usually first, then para-aortic • Hematogenous • Lung most common • Liver, brain, bone

  13. Treatment • Stage IB or less: total hyst/BSO/PPALND, cytology • Stage IC to IIB: total hyst/BSO/PPALND, cytology, adjuvant pelvic XRT • Stage III: total hyst/BSO/PPALND, cytology, adjuvant chemotherapy • Stage IV: palliative XRT and chemotherapy

  14. Histologic Types • Estrogen dependent • Endometrioid- most common • Non estrogen dependent- worse prognosis • Papillary Serous • Clear cell • Adenosquamous • Undifferentiated

  15. Other Types of Uterine Cancer • Leiomyosarcoma • Rapidly growing fibroid should be evaluated • Stromal sarcoma • Carcinosarcoma (MMMT) MMMT leiomyosarcoma