Endometrial Cancer

Symptoms

n Post menopausal bleeding

n Endometrial cells on Pap

n Perimenopausal with irregular heavy menses, increasingly heavy menses

n Premenopausal with abnormal uterine bleeding with history of anovulation

Differential Diagnosis for PMB

n Exogenous estrogen use- ie tamoxifen

n Atrophic endometritis/vaginitis

n Endometrial/cervical polyps

n Endometrial hyperplasia

n Endometrial Cancer

n Other gynecologic cancers

Risk factors for Endometrial Cancer

n Increased estrogen

– Hormone therapy

– Obesity

– Anovulation/PCOS

– Estrogen secreting tumors

– Older age

– Infertility

– Early menarche

– Late menopause

n Genetics

– HNPCC

– Caucasian

Preoperative Work-up

n Endometrial biopsy

n Ultrasound

n For suspected advanced stage may need:

– Cystoscopy

– Sigmoidoscopy

– Pelvic and Abdominal CT

n Labs

– CBC

– Chem 7

– Liver function tests

– EKG, CXR

Endometrial Hyperplasia (EIN)

n Precursor to endometrial cancer

– Risk of progression related to cytologic atypia

n Presents with abnormal bleeding

n Simple

– Benign irregular dilated glands

– No atypia: 1% progress

– Atypia: 8% progress

n Complex

– Proliferation of glands with irregular outlines, back to back crowding of glands, but no atypia

– No atypia: 3% progress

– Atypia: 29% progress

Staging of Endometrial Cancer

n I: Confined to uterine corpus

– IA: limited to endometrium

– IB: invades less than ½ of myometrium

– IC: invades more than ½ of myometrium

Staging of Endometrial Cancer

n II: invades cervix but not beyond uterus

– IIA: endocervical gland involvement only

– IIB: cervical stroma involvement

Staging of Endometrial Cancer

n 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

Staging of Endometrial Cancer

n IVA: invades bladder/bowel mucosa

n IVB: distant metastasis

Five Year Survival

n Stage I: 81-91%

– 72% diagnosed at this stage

n Stage II: 71-78%

n Stage III: 52-60%

n Stage IV: 14-17%

– 3% diagnosed at this stage

Spread Patterns

n Direct extension

– most common

n Transtubal

n Lymphatic

– Pelvic usually first, then para-aortic

n Hematogenous

– Lung most common

– Liver, brain, bone

Treatment

n Stage IB or less: total hyst/BSO/PPALND, cytology

n Stage IC to IIB: total hyst/BSO/PPALND, cytology, adjuvant pelvic XRT

n Stage III: total hyst/BSO/PPALND, cytology, adjuvant chemotherapy

n Stage IV: palliative XRT and chemotherapy

Histologic Types

n Estrogen dependent

– Endometrioid- most common

n Non estrogen dependent- worse prognosis

– Papillary Serous

– Clear cell

– Adenosquamous

– Undifferentiated

Other Types of Uterine Cancer

n Leiomyosarcoma

– Rapidly growing fibroid should be evaluated

n Stromal sarcoma

n Carcinosarcoma (MMMT)

This post was written by: Franklin Manuel

Franklin Manuel is a professional blogger, web designer and front end web developer. Follow him on Twitter