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Endometrial Cancer Steven Elg MD, PhD

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Endometrial Cancer Steven Elg MD, PhD

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    2. Ovarian Cancer: Stage Distribution and Survival American Cancer Society 2006

    3. Endometrial Cancer Type I Estrogen Related Younger and heavier patients Low grade Exogenous estrogen Type II Aggressive Unrelated to estrogen stimulation Occurs in older & thinner women Potential genetic basis Lynch syndrome Familial trend

    4. Ovarian Cancer: Stage Distribution and Survival American Cancer Society 2000

    5. Endometrial Cancer: Screening Patient Primary Cytology Not satisfactory Histology Secondary Hysteroscopy Not satisfactory Sonography Cost effective issue

    6. Endometrial Cancer: Who Needs an Endometrial Biopsy? Postmenopausal bleeding Postmenopausal women with endometrial cells on Pap Perimenopausal intermenstrual bleeding Abnormal bleeding with history of anovulation Thickened endometrial stripe via sonography

    7. Endometrial Cancer: Transvaginal Ultrasound Screening

    8. Endometrial Cancer: Survival by Clinical Stage

    9. Endometrial Cancer: FIGO Surgical Stage

    10. Endometrial Cancer: Poor Prognosis Factors Increasing age (over 65) Stage Vascular invasion Grade Histologic subtypes (Clear cell, Serous) Aneuploidy Cytokinetics Altered oncogene/tumor suppressor gene expression

    11. Endometrial Cancer: Nodal Involvement

    12. Endometrial Cancer: Pre-op Evaluation CA 125 Chest X-ray Mammograms Colon Evaluation Transvaginal Ultrasound Others

    13. Endometrial Cancer: Intra-operative principals Availability of frozen section Capability of complete surgical staging Capability of tumor reduction if indicated

    14. Endometrial Cancer: Surgical Staging Conceptual rationale Defines extent of disease Minimizes over/under treatment Minimally increases perioperative morbidity, mortality Decreases overall Rx risks and costs Allows comparison of therapeutic results

    15. Endometrial Cancer: Surgical Approach Complete hysterectomy, BSO/washings only Grades 1,2 <50% myometrial invasion Endometroid < 2cm tumor diameter

    16. Endometrial Cancer: Surgical Approach Complete surgical staging Grades 3 >50% myometrial invasion Serous/clear cell Advanced stages

    17. Endometrial Cancer: Adjuvant Therapy Brachytherapy External beam radiotherapy Hormonal therapy Cytotoxic chemotherapy Combination therapy

    18. Endometrial Cancer: Determinants of Adjuvant Therapy Stage Histologic subtypes Staging completeness Tumor biology Medical conditions

    19. Endometrial Cancer: Follow up Pelvic examination Pap smears CA 125 high risk Chest X-ray high risk

    20. Endometrial Cancer: Recurrence 80% of recurrences happen first three years Most will be symptomatic Rare to cure distant recurrences 50% vaginal recurrences cured

    21. Endometrial Cancer: Recurrence

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