SHRUTHI.S.JAYARAJ,53RD
CALICUT MEDICAL COLLEGE
ENDOMETRIAL CARCINOMA
DEVELOPED COUNTRIES CA
ENDOMETRIUM DEVELOPING COUNTRIES CA CERVIX
MOST COMMON CANCER OF GENITAL TRACT
POOR HYGEINE
MULTIPARITYEARLY
MARRIAGE
INCIDENCE IS HIGHEST IN U.S, LOWEST IN INDIA, JAPAN
PRIMARILY IN POST MENOPAUSAL LADIES
MEAN AGE ~ 60 yrs
RISK FACTOR
S
OESTROGEN
OTHERSOBESITY
DIABETESHYPERTENSION
HNPCC
OESTROGEN EXPOSURE
EXOGENOUS
HORMONE REPLACEMENT THERAPY
TAMOXIFEN FOR BREAST CANCER
ENDOGENOUSEARLY MENARCHELATE MENOPAUSEPCOSOBESITYFUNCTIONING OVARIAN TUMORS
HORMONE THERAPY FOR POST MENOPAUSAL LADIES :
‘FEMININE FOREVER’ !!!
OESTROGEN USED ALONE RISK
OESTROGEN + PROGESTINS RISK
SERM POTENT ANTAGONIST IN BREAST – Rx
of CA BREAST PARTIAL AGONIST IN UTERUS
LONG TERM USE- ENDOMETRIAL PROLIFERATION,CARCINOMA
TAMOXIFEN
COMBINED ORAL HORMONAL PILLS HAVE A PROTECTIVE EFFECT AND REDUSES RISK BY 40-50%
OBESITY REDUCES LEVEL OF SERUM HORMONE BINDING PROTEIN FREE ESTROGEN CIRCULATES IN BODY
PERIPHERAL FAT : CONVERSION OF EPIANDROSTENEDIONE TO OESTRONE
OBESITY
NULLIPAROUS WOMEN & WOMEN WITH PCOD
NON OVULATION HIGH OESTROGEN
ENDOMETRIAL HYPERPLASIA ENDOMETRIAL CANCER
RISK FACTOR
S
NULLIPARITYPCOSEARLY
MENARCHELATE
MENOPAUSE
OBESITYDIABETESHYPERTE
NSION
LYNCH 2 /
HNPCC
TAMOXIFEN
HRT
WOMEN WITH FAMILIAL LYNCH 2 SYNDROME (HNPCC) ARE LIKELY TO SUFFER FROM ENDOMETRIAL CANCER.
FAMILIAL PREDISPOSITION
TYPE 1
TYPE 2
TYPES
TYPE 1WELL
DIFFERENCIATEDGLANDS BACK TO
BACKMINIMUM STROMA
TYPE 2POORLY
DIFFERENCIATEDPREDOMINANTLY
SOLID PATTERNMINIMAL GLAND
FORMATION
55-65 YRS OESTROGEN DEPENDANT PREVIOUS H/O EXPOSURE TO UNOPPOSED OESTROGEN. a/w OBESITY/HYPERTENSION/DIABETES ‘WELL DIFFERENCIATED’ & MIMICS PROLIFERATIVE ENDOMETRIAL GLANDS.AS SUCH,REFERRED TO AS ENDOMETRIOD CARCINOMAEXCELLENT PROGNOSIS
TYPE 1 ENDOMETRIAL CARCINOMA
65 – 75 yrs OESTROGEN INDEPENDENT UNRELATED TO HORMONE EXPOSURE USUALLY ARISES IN AN ATROPHIC ENDOMETRIUMUSUALLY UNDIFFERENCIATED & AGGRESSIVEDEEP MUSCLE INVASION BAD PROGNOSIS
TYPE 2 ENDOMETRIAL CARCINOMA
TYPE 155-65 YRSESTROGEN
DEPENDENTENDOMETRIAL
HYPERPLASIA MAY BE PRESENT
WELL DIFFERENCIATED
65 – 75 YRSESTROGEN
INDEPENDENTUSUALLY IN
ATROPHIC ENDOMETRIUM
UNDIFFERENCIATED
TYPE 2
TYPE 1STABLEMINIMAL MUSCLE
INVASIONHISTOLOGY –
ENDOMETRIODEXCELLENT
PROGNOSIS
AGGRESSIVEDEEP MUSCLE
INVASIONHISTOLOGY-
SEROUS / CLEAR CELL
BAD PROGNOSIS
TYPE 2
ENDOMETRIAL CANCER MAY BE : LOCALISED/ DIFFUSE
APPEAR AS : NODULE POLYP DIFFUSE LESION INVOLVING WHOLE UTERINE CAVITY
MORPHOLOGY
LOCALISED
DIFFUSE
TO THE NAKED EYE THE ENDOMETRIAL CURETTINGS APPEAR PALE & FRIABLE
HISTOLOGICALLY 75 % ADENOCARCINOMA REST- SQUAMOUS / SEROUS
PATHOLOGY
GRADE 1 : WELL DIFFERENCIATED ADENO CARCINOMA
< 5 % SOLID GROWTH PATTERN
GRADE 2 : MODERATELY DIFFERENCIATED ADENOCARCINOMA 6 – 50 % SOLID GROWTH PATTERN
GRADE 3 : POORLY DIFFERENCIATED ADENOCARCINOMA
> 50 % SOLID GROWTH PATTERN
GRADING (FIGO)
GRADE 1 GRADE 2
GRADE 3
ENDOMETRIODMUCINOUSPAPILLARY SEROUSCLEAR CELLSQUAMOUSUNDIFFERENCIATED MIXED
PATHOLOGICAL CLASSIFICATION OF ENDOMETRIAL CARCINOMA
ENDOMETRIOD GOOD PROGNOSIS
MUCINOUS PAPILLARY SEROUSCLEAR CELL
BADPROGNOSIS
SQUAMOUS
COMMONEST TYPE ~ 80 %COMPOSED OF GLANDS WHICH
RESEMBLE NORMAL ENDOMETRIAL GLANDS
WELL DIFFERENCIATED & GOOD PROGNOSIS
ENDOMETRIOD
5 % OF CANCERSHAVE A MUCINOUS PATTERNWELL DIFFERENCIATED GLANDULAR
PATTERN GOOD PROGNOSIS
MUCINOUS
5 % ALL TUMORSEXHIBIT PAPILLARY PATTERNBEHAVE AGGRESSIVELY POOR PROGNOSISHIGH RISK FOR LYMPHOVASCULAR SPACE
INVOLVEMENT AND DEEP MYOMETRIAL INVASION EVEN WITH EARLY STAGE DISEASE
SPREAD EARLY TO ABDOMEN
PAPILLARY SEROUS
5 % OF ALL CANCERSCELLS LARGE WITH ATYPICAL
NUCLEI,CLEAR CYTOPLASM, CONTAIN GLYCOGEN
MAY SHOW HOBNAIL CONFIGURATION AND FORM PAPILLARY STRUCTURES
HIGHLY AGGRESSIVEBAD PROGNOSIS
CLEAR CELL CARCINOMA
c
A B
VERY RARE VARIETYR/O SPREAD FROM CERVICAL SQUAMOUS
EPITHELIUMVERY POOR PROGNOSIS EVEN WITH
STAGE 1 DISEASE
SQUAMOUS
CLINICAL FEATURES
ASYMPTOMATIC IN 7- 10 %MANIFEST AS MENORRHAGIA & IRREGULAR PERIODS
PERIMENOPAUSAL LADIES POST MENOPAUSAL BLEEDING IN
MENOPAUSAL WOMAN
ELDERLY WITH CERVICAL STENOSIS
HAEMATOMETRA/PYOMETRA
PURULENT VAGINAL DISCHARGE
SOME WOMEN EXPERIENCE PELVIC PRESSURE AND PAIN DUE TO UTERUS ENLARGEMENT OR EXTRAUTERINE SPREAD
ADVANCED STAGE- BULKY CERVIX,
GROWTH PROTRUDING THROUGH OS
THANK YOU