Endometrial Carcinoma

CLASSIFICATION:
Endometrial carcinomas can be classified into two pathogenetic groups:
  • Type I: These cancers occur most commonly in pre- and peri-menopausal women, often with a history of unopposed estrogen exposure and/or endometrial hyperplasia. They are often minimally invasive into the underlying uterine wall, are of the low-grade endometrioid type, and carry a good prognosis.
  • Type II: These cancers occur in older, post-menopausal women, and are not associated with increased exposure to estrogen. They are typically of the high-grade endometrioid, papillary serous or clear cell types, and carry a generally poor prognosis
RISK FACTORS:
  • High levels of estrogen
  • Endometrial hyperplasia( Complex hyperplasia with atypia histological pattern)
  • Polycystic ovary syndrome
  • Nulliparity
  • Infertility
  • Early menarche
  • Persistent anovulation
  • Diabetes mellitus
  • Hypertension
  • Obesity, 
  • Family History, 
  • Use of Hormone Replacement Therapy
  • Late menopause
  • Endometrial polyps or other benign growths of the uterine lining
  • Tamoxifen
  • Hyperplasia
  • Pelvic radiation therapy
  • Breast cancer
  • Ovarian cancer
CLINICAL FEATURES:
  • A Pap smear may be either normal or show abnormal cellular changes.
  • Most common cause of postmenopausal vaginal bleeding 
  • Endometrial curettage is the traditional diagnostic method.
  • If endometrial curettage does not yield sufficient diagnostic material, a dilation and curettage (D and C) is necessary for diagnosing the cancer.
  • Endometrial biopsy or aspiration may assist the diagnosis.
  • Transvaginal ultrasound to evaluate the endometrial thickness in women with postmenopausal
  • The most malignant endometrial carcinoma is Clear cell carcinoma
PATHOLOGY:
  • The most common finding is a well-differentiated endometrioid adenocarcinoma, which is composed of numerous, small, crowded glands with varying degrees of nuclear atypia, mitotic activity, and stratification.
FURTHER EVALUATION:
  • Colonoscopy is recommended due to the etiologic factors common to both endometrial cancer and colon cancer.
  • D and C is useful in the diagnosis 
STAGING:
  • Endometrial carcinoma is surgically staged using the FIGO cancer staging system.
i a. Stage IA: tumor is limited to the endometrium
i b. Stage IB: invasion of less than half the myometrium
i c. Stage IC: invasion of more than half the myometrium
ii a. Stage IIA: endocervical glandular involvement only
ii b. Stage IIB: cervical stromal invasion
iii a.Stage IIIA: tumor invades serosa or adnexa, or malignant peritoneal cytology
iii b.Stage IIIB: vaginal metastasis
iii c. Stage IIIC: metastasis to pelvic or para-aortic lymph nodes
iv a. Stage IVA: invasion of the bladder or bowel
iv b.Stage IVB: distant metastasis, including intraabdominal or inguinal lymph nodes (bleeding PV and en­larged inguinal nodes)


TREATMENT:
  • Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer.
  • Fractional curettage can be done in endometrial carcinoma
  • Penetration into half of myometrium, Clear cell Ca & Fundal involvement are indications of direct lymph node dissec­tions in endometrial carcinoma
  • Treatment for stage IV is Radiotherapy, Chemotherapy and hormonal therapy
Exam Question of :
  • Fractional curettage can be done in endometrial carcinoma
  • Persistent anovulation not treated leads to Endometrial Carcinoma
  • Poly cystic ovarian disease is associated with Endometrial carcinoma
  • Obesity, Family History, Use of Hormone Replacement Therapy are known risk factors for de­velopment of endometrial carcinoma
  • Endometrial carcinoma is Predisposed by diabetes mellitus, hypertension and obesity
  • Bleeding PV and en­larged inguinal nodes is seen in satage IV of endometrial carcinoma
  • Penetration into half of myometrium, Clear cell Ca & Fundal involvement are indications of direct lymph node dissec­tions in endometrial carcinoma
  • The most malignant endometrial carcinoma is Clear cell carcinoma
  • Stage IV endometrial carcinoma, treatment is Radiotherapy, Chemotherapy and hormonal therapy
  • D and C is useful in the diagnosis of endometrial carcinoma
  • Most common cause of postmenopausal vaginal bleeding is endometrial carcinoma
  • Use of tamoxifen for breast cancer can cause endometrial carcinoma
  • The risk of endometrial carcinoma is the highest with the Complex hyperplasia with atypia histological pattern of endometrial hyperplasia
  • In Endometrial carcinoma, PTEN is the tumor suppressor gene
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