Transcript 子宫内膜癌
Endometrial Carcinoma Women’s Hospital, School of Medicine, Zhejiang university General Considerations Endometrial carcinoma is one of the most three common pelvic genital cancer in women. It is malignant epithelioid tumor. The incidence of endometrial cancer has now raised. The peak incidence of onset is in the age 58-61 years. Etiology Etiology of endometrial carcinoma may involve two mechanisms estrogen-dependent estrogen-independentcertain Pathology Endometrioid adenocarcinoma Serous adenocarcinoma Clear cell carcinomas Mucus adenocarcinoma Others METASTASIS Direct invasion Lymphatic metastasis Vascular metastasis(advanced stage) SYMPTOMS mostly of the disease occurs in the elder patients,there is no symptoms at the very early stage and it is only discovered by examine. abnormal vaginal bleeding vaginal fluiding pelvic pain weakness, weight loss, and anemia SIGNS Physical examination is usually unremarkable at the very early stage The uterus may be enlarged and the mass may move out of the cavity in the advanced cases Some signs of metastasis can be found of the late stages of the disease Diagnosis History：clinical representation and high risk factor, family history vaginal bleeding High-risk factors Long term use of E2,TAM Family history of breast cancer and endometrial carcinomas Signs Special Examinations Fractional curettage Endometrial biopsy Endocervical curettage Diagnose of endometrial carcinoma needs the pathologic results Special Examinations Endometrial cytology exam are also used in some patients Ultrasonography can be helpful in deciding clinical staging, In postmenopausal women, 4mm is the cut off for a normal unilateral endometrial stripe The function of cavityscopy is controversy MRI and CT appear to improve the accuracy of clinical staging and is particularly helpful in identifying myometrial invasion Serum CA-125, a well-established tumor marker can also be useful for endometrial cancer Differentiation Dysfunctional uterine bleeding in the menopause women Senile vaginitis Endometrial polypus Pelvic genital cancer in women Endometritis in elders CLINICAL STAGE According to anatomic sites Stage I： endometrium Stage II： cervix Stage III: parametrial，within pelvis Stage IV：beyond metastasis Staging Clinical staging(FIGO1971) According to the Fractional curettage and clinical examination Pre-operation staging Used in the patients who treat Radiation as primary therapy Surgical-pathological staging (FIGO2009) the last staging for the patients who choose surgery as the principal therapy It is the last staging for the majority Staging THERAPY Treatment plan for endometrial carcinoma depends on it’s clinical staging and common condition Surgery , radiation therapy and drugs are all in use Primary surgery with concomitant therapy is the main treatment in the early stage patients While in the late stages of the disease include radiation, surgery and drugs therapy. THERAPY Surgical treatment : Primary treatment, especially in the early stages Purpose Definitude the staging and prognostic factors Excise the lesion SURGICAL TREATMENT Clinical stage Ⅰ Simple hysterectomy and bilateral salpingooophorectomy has been recommended Make sure to obtain peritoneal washings for cytologic identification of occult spread The uterus should be opened in the operating room to determine the need for lymphadenectomy SURGICAL TREATMENT The need for lymphadenectomy Special pathological type Greater than 50% myometrial invasion Low differentiation（G3） > 50％ cavity be involved by the lesion Cervical extension SURGICAL TREATMENT Clinical stage II Radical hysterectomy and bilateral salpingooophorectomy has been recommended Pelvic and para-aortic lymphadenectomy is necessary Make sure to obtain peritoneal washings Open the uterus in the operation Expect the PR and ER receptors. SURGICAL TREATMENT Clinical stage Ⅲ，Ⅳ cytoreductive surgery should be attempted if possible RADIATION THERAPY Radiation therapy simply is used in patients with operation forbiddance or in the late stages. Postoperative adjuvant radiation therapy is indicated in patients with extrauterine extension lower uterine segment or cervical involvement myometrial invasion >1/2 poor histologic differentiation papillary serous or clear cell histology RADIATION THERAPY Adjuvant radiation therapy preoperatively is indicated in reducing tumor size to create operation condition and eliminate the hiding metastasis lesion. Radiation therapy can be carried out inside or outside body. HORMONE THERAPY Progesterone has been the treatment of recurrent endometrial carcinoma not amenable to irradiation or surgery. Patients who are young also use progesterone therapy to keep fertility. The drugs are manual composed with high dose. curative effect should be estimated every 2-3 months Tamoxifen has been used as another hormonal agent in advanced or recurrent endometrial cancer ANTITUMOR CHEMOTHERAPY Chemotherapy of single drug or combined drugs is appropriate in the advanced or recurrent endometrial cancer. Follow-up Time ： 2-3rd year: once every 3 months 3-5th year: once every 6 months >5th year: once every year Content ： pelvic examination cytological exam of the residual vagina chest X-Ray, CA125