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Endometrial Cancer

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

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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

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