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Carcinoma
General considerations
Most occur in the sixth and seventh
decades.
Incidence : 1.3%-2.4%
Consequent: the overall prognosis is
better.
Etiology
Unknown
Estrogen ( diabetes mellitus,
hypertension, polycystic ovary
syndrome, obesity, tamoxifen. )
Family history: ovarian, colon, or
breast cancer.
Certain oncogenes: Ha-, K-, N-ras, c-
myc, Her-2/neu, p53, PTEN
Histopathologic
classification
Endometrial hyperplasia: simple;
complex; atypia
Hyperplasia without atypia: simple–
1% Ca. Complex– 3% Ca. -- not
considered premalignant.
Hyperplasia with atypia: respectively
8%- simple and 29%- complex
become Ca.
Carcinoma in situ:
Endometrial carcinoma
Adenocarcinoma :
Adenocarcinoma with squamous
differentiation:5%
Adenosquamous carcinoma:10-20%,
prognosis is worse
Serous carcinoma: spread early.
Clear cell carcinoma:
Miscellaneous subtypes:
Possible routes of spread
Direct extension
Lymphatic metastases
Peritoneal implants after
transtubal spread
Hematogenous spread
Surgical staging
Stage I: 75% a—limited to
endometrium; b—less than ½; c—
invasion more than ½
Stage II: 11% a—endocervical
glandular invovement only; b—
cervical stromal invasion
Stage III: 11% a—serosa, adnexa,
peritoneal; b—vaginal metastases; c
—pelvic or aortic lymph nodes
Stage IV: 3% a—bladder or bowel
mucosa; b—distant metastases.
Clinical findings
Symptoms and signs: abnormal
bleeding; abnormal discharge;
( postmenopausal bleeding – 20%
underlying cancer; 12-15%
endometrial carcinoma; others–
sarcoma…>80ys ½ cancer ); lower
abdominal cramps and pain;
Bimanual or rectovaginal
examination: enlarged, soft,
pyometra.
Clinical findings
Laboratory
findings: anemia;
pap smear;
Clinical findings
Special examination:
1. Fractional curettage.
2. Endometrial biopsy: aspiration
biopsy; aspiration curettage
3. Pelvic ultrasonography
4. Estrogen and progesterone
receptor assays: patients with
receptors positive have longer
survival than negative.
Differential diagnosis
Abortion
Leiomyoma, hyperplasia, polyps,
genital cancer. Ovarian neoplasms.
Metastatic cancers.
Atrophic vaginitis; exogenous
estrogens; endometrial hyperplasia
and polyps; genital neoplasms.
D and C negative – tubal and ovarian
cancer? –hysterectomy and bilateral
salpingo-oophorectomy
Complications
Perforation
Peritonitis
Pyometra
Anemia
Treatment
Surgery and radiation
Surgical treatment
Hysterectomy
Radical hysterectomy
Radiation therapy
Extrauterine extension
Lower uterine segment or cervical
involvement
Poor histologic differentiation
Papillary serous or clear cell
histology
Myometrial penetration greater
than1/3 of the full thickness
Hormone therapy
Progesterone
>3 months
Antitumor chemotherapy
Doxorubicin
Cisplatin
Carboplatin
Cyclophosphamide
5- fluorouracil
General and supportive
measures
Most patients with weak, anemia,
diabetes, hypertension, and so on.
Prognosis
Worse – high age; higher pathologic
grade; clinical stage; greater depth
of myometrial invasion.
5-year survival rates: 81-91% for
surgical stage I; 67-77% for stage II;
31-60% for stage III; 5-20% for stage
IV.
No risk factors – TAH+ bilateral
salpingo-oophorectomy >95% at 5
years.
Prevention
Estrogen + progesterone for one
cycle.
Monitor high risk patients.