Endometrial Carcinoma

Crcinoma Endometrium
By
Prof Bilqis Afridi (FRCOG)



l 90 % of cancers ……..Corpus
l Body of Uterus
l
l Small Group ……….Sarcomas
l (arising from myometrium)
l

Natural History

l Not well understood

l No effective screening test

l Certain risk factors

Epidiamology
App. 4000 new cases / year in Uk

l15 in 100,000 woman / year

lTends to present early

lCarries best prognosis of gynaecological cancers.

lOverall 5-year survival rate app 70 %----- 80 %

Occurrences
lprimarily

lPostmenopausal women

lRare < 40 yrs


Risk factors
l Causes ………Still ill understood
l Condition ………Increase estrogen …………… Increase risk
l Examples

l1- HRT ( unapposed estrogen)
l2- Endometrial hyperplasia or even Carcinoma
(ass with Granulosa cell tumor …….Increase
estrogen).



l3-Obesity
l 4- PCO
l 5-Early Menarche
l 6-late menopause
l 7-Nulliparity
l 8 +ve family History
l 9- DM
Clinical Presentation
lHistological Type
Adenocarcinoma (commonest )

lClinical Presentation
Generally ® PMB

More Unusually® Irregular menstrual Bledin
(Before menopause )

Early sign ® Irregular P/V Bleeding


Early Diagnosis

l Early sign …………..Irregular P/V Bleeding
l
l Investigation
l
l
lDiagnosis Usually made before disease spread
l
l50% Postmenopausal Discharge with a Pyometra










l Frequently

l No clinical sign of endometrium Cancer
l ( Changes lie within Endometrium)
l
l Necessary Endometrial Biopsy
l
Conventional Method EUA & D&C
l
l Out patient
l Hystroscopic guided endometrial Biopsy
l (More Reliable)

l More Recent TVS
l
Studies Shows When Endometrial echo is < 5mm then Ca Endometrium Can be excluded.
l


Treatment
l Biopsy Ca Endometrium
l
Surgical ( Standard Treatment)

l TAH with BSO
l
2- If more advanced
l
l affecting Cx or Adnexa
l
more aggressive surgery (may be)

Spread
l Spread Initially either
l 1 Direct Spread
Affecting Cx

2- Indirect spread
l Affecting Pelvic
l para aortic L nodes

l It is b/c of No 2 that some advocate Pelvic Lymphadenectomy at time of TAH.


Staging

l
l When the tumor is examined by the pathologist particular attention to
l
l1- Depth of Invasion
l2- Degree of Differentiation
l3- Grade of tumor
l

Proper Staging
l Staging
l
l
l
l After surgical & Pathological
l Evaluation
l
l

Adverse Prognostic Factors

l Poorly Differtiated Tumors

l Deep Myometrial Invasion

lPositive Peritoneal Cytology

lPelvic or Para aortic nodes involvement

lLymph and Vascular space involvement

lAdenosquamous or Papillary serous tumors

Further Treatment
l
lDecision of further treatment
l
l Rests with Pathologial
l &
l Surgical findings
l


Radiotherapy
Externaal Beam therapy /Teletherapy

l To control recurrence
l Vault Brachy Therapy

l To prevent vault Recurrence
l Radiotherapy

l Similar Morbidity as with radiation for Ca Cx

l Bowel Bladder Dysfuction
l

5 year Survival rates
Stage 1 ……………85%

lAlthough within Stage 1 High risk tumors

Lower Survival Rate

lOverall …………….70%




Uterine Sarcomas
l Much Less common
l Present as Uterine Mass with vaginal Bleeding
l
l Range from Low grade malignancy (excessive mitosis)
l To
l
lHigh Grade or very aggressive tumor ( often with Para -aortic L Nodes Involvement)
l

l
l
Management
l Surgical

lTo remove uterus if possible

lIf any residual disease

Treatment difficult ( No reliable therapy available )

lCombination Chemotherapy used

lRadiation also not very effective


Key Points

l Disease mainly effects postmenopausal women

lMost patients present early

lPrimary treatment Hystrectomy

lAdjuvant Radiotherapy to the pelvis is used
if poor prognostic feature in stage 1
or
spread beyond corpus.


Treatment Of recurrent Disease
If Confined To the Pelvis

l1-May be treated by Radiotherapy If feasible

l2-Radical Surgery Including Pelvic Exenteration
Where distant spread has been actively excluded
Extra pelvic Disease
lHarmones

lOr

lChemotherapy

lBoth associated with limited survival.




THANK YOU