Transcript Malignant disease of the body of the uterus

Malignant disease
of the body of the uterus
uterine cancer.
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Endometrial cancer may sometimes be
referred to as uterine cancer. However,
different cancers may develop not only
from the endometrium itself but also
from other tissues of the uterus, including
cervical cancer, sarcoma of the
myometrium, and trophoblastic disease.
Corpus cancer accounts for 3% of cancer
in females.
 1.Endometrial carcinoma which arise from
the lining of the uterus.
 2.Sarcoma arise from the stroma of
endometrium or from myometrium.
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Endometrial carcinoma
The incidence is at 60 years & more .
 75% of cases usually occur in the post
menopausal period
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Risk factors for Endometrial Cancer
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high levels of estrogen
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endometrial hyperplasia
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obesity
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hypertension
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polycystic ovary syndrome[citation needed]
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nulliparity (never having carried a pregnancy)
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infertility (inability to become pregnant)
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early menarche (onset of menstruation)
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late menopause (cessation of menstruation)
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endometrial polyps or other benign growths of the uterine lining
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diabetes
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Tamoxifen
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high intake of animal fat[citation needed]
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pelvic radiation therapy
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breast cancer
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ovarian cancer
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heavy daily alcohol consumption (possibly a risk factor)
[3]
Factors reduce risk of endometrial
carcinoma
oral contraception.
 progestogens.
 Smoking.
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Pathology
The histopathology of endometrial cancers is highly diverse. 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. This often appears on a background of endometrial hyperplasia.
Lymphatic spread occurs later and is less frequent than in cases of cervical carcinoma.
Remote metastases in lungs, bones or else-where are not common but occur more
often than with cervical carcinoma
Clinical presentation
Symptoms
1.The classic symptom is bleeding
 A. Post menopausal bleeding in 75-80 %.
 This symptom should be assumed to be caused by
carcinoma of endometrium until proved otherwise.
Women with post menopausal bleeding in women
not taking hormone replacement therapy has 10%
risk of having a genital tract cancer
 B. In premenopausal women may present as:
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* intermenstrual bleeding
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*menorrhagia.
 2. Watery or purulent vaginal discharge (blood
stained).
 3. Pain is a late symptom and denotes extensive
spread of disease.
 4. Abnormal screening test.
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Signs
 A full general and systematic examination is
indicated.
 Enlarged lymph nodes in the groin or
supraclavicular fossa may be found.
 Breast should be palpated.
 Uterine enlargement can be palpated.
 Pelvic examination:
 Bleeding through cervix.
 Secondary metastasis in vagina, urethra.
Investigations
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A Pap smear may be either normal or show abnormal cellular
changes.
Endometrial curettage is the traditional diagnostic method. Both
endometrial and endocervical material should be sampled.
If endometrial curettage does not yield sufficient diagnostic
material, a dilation and curettage (D&C) is necessary for diagnosing
the cancer.
Hysteroscopy allows the direct visualization of the uterine cavity
and can be used to detect the presence of lesions or tumours. It
also permits the doctor to obtain cell samples with minimal damage
to the endometrial lining (unlike blind D&C).
Endometrial biopsy or aspiration may assist the diagnosis.
Transvaginal ultrasound to evaluate the endometrial thickness in
women with postmenopausal bleeding is increasingly being used to
evaluate for endometrial cancer.
An endometrial thickness exceeding 4 to
5 mm on ultrasound is suggestive of
endometrial pathology in such women.
 Sonohysterography:
 It may improve delineation of endometrial
polyps.
 both D&C and Pipelle biopsy curettage
give 65-70% positive predictive value. But
most important of these is hysteroscopy
which gives 90-95% positive predictive
value.
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Recently, a new method of testing has been
introduced called the TruTest, offered
through Gynecor. It uses the small flexible
Tao Brush to brush the entire lining of the
uterus. This method is less painful than a
pipelle biopsy and has a larger likelihood of
procuring enough tissue for testing. Since it
is simpler and less invasive, the TruTest can
be performed as often, and at the same time
as, a routine Pap smear, thus allowing for
early detection and treatment
Magnetic resonance imaging (MRI):
 It is expensive and not practical to screen
all women.
 It used for evaluation of endometrial
thickness and to predict myometrial
invasion.
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Staging of Endometrial Cancer
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I: Confined to uterine corpus
◦ IA: limited to endometrium
◦ IB: invades less than ½ of myometrium
◦ IC: invades more than ½ of myometrium
Staging of Endometrial Cancer
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II: invades cervix but not beyond uterus
◦ IIA: endocervical gland involvement only
◦ IIB: cervical stroma involvement
Staging of Endometrial Cancer
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III: local and/or regional spread
◦ IIIA: invades serosa/adnexa, or positive cytology
◦ IIIB: vaginal metastasis
◦ IIIC: metastasis to pelvic or para-aortic lymph nodes
Staging of Endometrial Cancer
IVA: invades bladder/bowel mucosa
 IVB: distant metastasis
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Five Year Survival
Stage I: 81-91%
72% diagnosed at this stage
 Stage II: 71-78%
 Stage III: 52-60%
 Stage IV: 14-17%
3% diagnosed at this stage
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Spread Patterns
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Direct extension
◦ most common
Transtubal
 Lymphatic
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◦ Pelvic usually first, then para-aortic
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Hematogenous
◦ Lung most common
◦ Liver, brain, bone
Treatment
Stage IB or less: total hyst/BSO/
 Stage IC to IIB: total hyst/BSO/ adjuvant
pelvic XRT
 Stage III: total hyst/BSO/ adjuvant
chemotherapy
 Stage IV: palliative XRT and chemotherapy
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Methods of Endometrial Cancer
Treatment:
The treatment of endometrial carcinoma
is usually:
 * surgical.
 * Radiotherapy
 * Hormone therapy: Progestogens
inhibit the rate of growth and spread of
endometrial carcinoma.
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Other Types of Uterine Cancer
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Leiomyosarcoma
◦ Rapidly growing fibroid should be evaluated
Stromal sarcoma
 Carcinosarcoma

chorioca
leiomyosarcoma
Uterine Sarcomas
Account for fewer than 10% of all corpus cancers.
 Types:
 ( Carcinosarcoma, leiomyosarcoma, Endometrial stromal sarcoma,
adenosarcoma)
 Exposure to radiation may enhance the development of pelvic
sarcomas
 Abnormal vaginal bleeding most frequent presenting symptom for
all histologic types.
 No specific staging system (commonly use staging of endometrial
carcinoma)
 Management of Uterine Sarcomas:
 Surgery is the hallmark of treatment with total abdominal
hysterectomy and bilateral salpingo-oopherectomy (TAH/BSO)
being the standard procedure.
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