Transcript Endometrial Cancer – Uterine Cancer

Uterine & Ovarian Cancer
Uterine Cancer
I.
A.
B.
C.
D.
E.
F.
G.
Atypical Hyperplasia
From hyperplasia to endometrial cancer
Prevalence & Incidence
Causes
Risk factors
Detection
Treatment
Ovarian Cancer
II.
A.
B.
C.
D.
Risk factors
Symptoms
Detection
Treatment
I. Endometrial Cancer – Uterine Cancer
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Endometrial cancer usually begins in the
lining of the uterus (endometrium). It is
sometimes called uterine cancer.
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Vast majority are adenocarcinomas – commonly
detected during perimenopause
but there are other cells in the uterus that can
become cancerous — such as muscle or
myometrial cells.
A. Atypical Hyperplasia = abnormal tissue growth
1)
2)
3)
simple hyperplasia without atypia = a
proliferation of cells, but the basic structure of the
endometrium is relatively unchanged
complex hyperplasia without atypia = individual
cells may be enlarged, but the internal makeup of
the cells is considered to be normal. However, the
cells have proliferated to the point where the
normal structure of the endometrium is interfered
with.
Hyperplasia with atypia = precancerous,
Approximately 25-30% of hyperplasia in this
category will progress to endometrial cancer.
B. From hyperplasia to endometrial cancer
C. Prevalence & Incidence
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ACS predicts that 41,200 American women will
receive a diagnosis of “uterine” endometrial cancer
this year, making it the fourth most common cancer
found in women — after breast cancer, lung cancer
and colon cancer.
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Although this cancer is 40% more common in white
women, black women are nearly twice as likely to
die from it.
D. What causes endometrial cancer?
E. Risk Factors
1)
2)
3)
4)
5)
6)
obesity -- particularly being more than 50 pounds overweight
(fat tissue can convert other hormones in the body into
estrogens)
type 2 diabetes - some data suggest that women who have
diabetes, whether they're obese or not, are at greater risk of
endometrial cancer
early menstruation (periods starting before age 12) & late
menopause (after age 52)
nulliparity (never having given birth) or a history of infertility (an
inability to become pregnant)
ovarian diseases, such as polycystic ovaries, that may cause a
woman to have higher than normal estrogen levels and lower
than normal progesterone levels
estrogen-only replacement therapy (ERT)
Additional potential contributors:
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Family history – possible genetic link
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Hereditary nonpolyposis colorectal cancer (HNPCC).
Inherited disease caused by an abnormality in a gene
important for DNA repair. Women with HNPCC also have a
significantly higher risk of endometrial cancer.
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Personal history of breast cancer or ovarian cancer
–
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Stress
F. Symptoms of endometrial cancer
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Abnormal uterine bleeding
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Heavy bleeding during or between periods, and bleeding
after menopause.
More frequent vaginal bleeding or spotting during the years
leading up to menopause.
In some cases, the discharge associated with
endometrial cancer is pink, or white rather than red.
Difficult or painful urination or pain during
intercourse.
In later stages of the disease, women may feel
pelvic pain and experience unexplained weight loss.
G. Detection
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Transvaginal
ultrasound
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Hysteroscope
Hysteroscope allows doctors to
do a direct visual examination
of the endometrium.
The lighted tip of the instrument is
inserted through the vagina and
cervix into the uterine cavity.
There the doctor can inspect any
abnormal tissues and, using a tiny
electrified loop, can even take
samples for later lab analysis.
Additional Diagnostic Tests
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CA-125 blood test –
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Cystoscopy (to check for cancer in the bladder)
Proctoscopy (to check for cancer in the rectum)
Other imaging tests such as computed tomography
(CT) scanning and magnetic resonance imaging
(MRI), chest x-ray, or an intravenous pyelogram (xrays of the pelvic region taken after the injection of a
contrasting agent)
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H. Treatment
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Treatment of hyperplasia without atypia
Treatment of hyperplasia with atypia
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The suggested treatment for atypical complex hyperplasia is usually
hysterectomy
In pre-menopausal women who wish to conceive, high dose
progestin treatment with close monitoring is an accepted alternative
to hysterectomy
Cancer - Options for treatment depend chiefly on the stage of the
disease (the size of the cancer, the depth of invasion, and whether
the cancer has spread to other parts of the body).
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Radiation therapy and/or chemotherapy may be necessary
Stages for endometrial cancer are:
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Stage I. Cancer is limited to the uterus.
Stage II. Cancer involves the uterus and
cervix.
Stage III. Cancer has spread out of the uterus
but is restricted to the pelvic region.
Stage IV. Cancer has spread to the bladder,
bowel, or other distant locations.
Survival rates
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5 year survival rates for endometrial cancer
by stage are:
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Mayo Clinic Site
http://www.mayoclinic.com/health/endometrial
-cancer/DS00306
II. Ovarian Cancer

For most pre-menopausal women, a
growth on the ovary is benign (90%) – for
post-menopausal women there is a 70%
chance of it being benign
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Tumor growth that begins in the egg-producing
cells (germ cell tumors) –
Tumor growth that begins on the surface of the
ovary (epithelial cell tumors)
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epithelial cell tumors
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Tumors of low malignant potential (LMP tumors) do not
appear to be clearly cancerous.
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AKA borderline tumors.
affect women at a younger age than other ovarian cancers.
grow slowly and are much less serious than most ovarian
cancers.
Epithelial ovarian cancers: Nearly 9 out of 10 ovarian
cancers are of this type.
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Grade 1 means the cells look more normal
Grade 2 somewhat abnormal
Grade 3 look highly abnormal.
Prevalence & Incidence
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An estimated 20,180 women will be
diagnosed with ovarian cancer in the US in
2006.
This year, about 15,310 women will die of the
disease –
A. Risk Factors
1)
2)
3)
4)
5)
6)
7)
Continuous egg production (never pregnant, never used birth
control, or first birth after age 30)
Early menstruation (periods starting before age 12) or late
menopause (after age 52)
Obesity
Diet – saturated fat increases risk, high fiber lowers risk
Fertility drugs – studies indicate prolonged use clomiphene
citrate, especially without achieving pregnancy, may increase
the risk for developing LMP tumors.
Estrogen replacement therapy? - A recent study suggested that
using ERT increases the risk of developing ovarian cancer, and
that the risk increases with continued use.
Genetics? the risk is higher among women whose close blood
relatives (mother, sister, daughter) have (or had) this disease.
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<10% of women found to have ovarian cancer have inherited the
disease
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BRCA1 and BRCA2 are implicated in ovarian cancer too
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Family history breast cancer
B. Symptoms of ovarian cancer
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Swelling of the stomach (abdomen) from a buildup
of fluid
Unusual vaginal bleeding
Pelvic pressure, cramps
Unexplained changes in bowel habits, including
diarrhea or constipation
Changes in bladder habits, including a frequent
need to urinate
Loss of appetite
Back or leg pain
Problems such as persistent gas, bloating, long-term
stomach pain, or indigestion
C. Detection
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Often called the “silent cancer”
D. Treatment
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How much and what type of surgery depends on
how far the cancer has spread, general health, and
whether or not she still hopes to have children
For LMP tumors:
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Unilateral Oophorectomy Bilateral oophorectomy –
Uni/bilateral salpingectomy –
Debulking – shrinking of the tumor
Radical hysterectomy + removal of omentum (fat
pad that surrounds the intestines)
Radiation and/or chemotherapy
Stages of ovarian cancer
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Stage I: The cancer is contained within the ovary (or
ovaries).
Stage II: Cancer is in one or both ovaries and has
spread to other organs in the pelvis, such as the
bladder, rectum, or uterus.
Stage III: The cancer is in one or both of the ovaries
and has spread to the lining of the abdomen or to
the lymph nodes.
Stage IV: This is the most advanced stage. The
cancer has spread from one (or both) ovaries to
distant organs, such as the liver or lungs.
Survival rates after 5 years
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Medline site:
http://www.nlm.nih.gov/medlineplus/ovarianca
ncer.html
Disease risk questionnaire
http://www.yourdiseaserisk.harvard.edu/hccp
quiz.pl?lang=english&func=home&quiz=ovari
an