Endometrium Inner membrane of the mammalian uterus.
Endometrium Lining for the uterus Preventing adhesions between the opposed walls of the myometrium. Soft and spongy. Each month endometrium change as part of menstrual cycle.
What is Endometrial Cancer?
Cause The exact cause is unknown. Estrogen
-to treat the symptoms of menopause.
help prevent osteoporosis.
by taking the hormone progestogen
along with estrogen, the risk of endometrial cancer is reduced substantially Risk Factors Women who have been treated with tamoxifen, a drug used to prevent and treat breast cancer, may have a slightly increased risk of developing endometrial cancer. Sex, Age, Family History Irregular menstrual periods Early first menstruation or late menopause Infertility Obesity Diabetes Hypertension Estrogen replacement therapy and/or Tamoxifen
an endoscope is used to guide the endometrial
biopsy or D&C.
he tube is inserted into the uterus through the
A hysteroscopy allows the doctor to view the
inside of the uterus while collecting endometrial tissue samples.
Endometrial stromal sarcoma gross
Signs and symptoms
Vaginal bleeding and/or spotting in postmenopausal women. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.
Bleeding between normal periods in premenopausal women in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes).
Anemia, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.) Lower abdominal pain or pelvic cramping. Thin white or clear vaginal discharge in postmenopausal women. Weight loss.
TYPE OF ENDOMETRIAL CANCER Type 1
caused by excess estrogen
experts aren't sure what causes type 2 cancers, but they don't seem to be caused by too much estrogen
TYPE I not very aggressive slow to spread to other tissues grades 1 and 2 endometrial cancers are "type 1" endometrial cancer occur most commonly in pre- and peri-menopausal women history of unopposed estrogen exposure and/orendometrial hyperplasia carry a good prognosis.
TYPE II occur in older, post-menopausal women more common in African-Americans more likely to grow and spread outside of the uterus carry a poorer prognosis
Example of type I cancer Endometrial adenocarcinoma
most common type of uterine cancer
it arises from the glands of the endometrium
About 80% of uterine cancers are adenocarcinomas, and they have varying aggressiveness.
The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope.
While "Grade I" looks a lot like normal uterine tissue and can be very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior.
About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III
Example of type II cancer the uterine papillary serous carcinoma the uterine clear cell carcinoma
High-grade endometrioid cancer
Uterine papillary serous carcinoma
Uterine papillary serous carcinoma uterine papillary serous carcinoma (UPSC) is an uncommon form of endometrial cancer that typically arises in postmenopausal women. is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers. It is typically diagnosed on endometrial biopsy, prompted by post-menopausal bleeding. It arises in the setting of endometrial atrophy and is classified as a type II endometrial cancer.
uterine clear cell carcinoma
uterine clear cell carcinoma Uterine clear cell carcinoma (CC) is a rare form of endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate. is an aggressive cancer accounting for about 2% of uterine cancers. It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used. Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium.
Treatment for endometrial cancer Depends on the stage of the disease and the overall health of the patient. Primary treatment is the surgery (removal of the tumor ). Radiation therapy, hormone therapy, and/or chemotherapy may be used as adjuvant treatment (i.e., in addition to surgery) in patients with metastatic or recurrent disease.
Surgery Surgery(removing the tumor in an operation) for endometrial cancer is also known as hysterectomy which the uterus is surgically removed with or without other organs or tissues.
Total hysterectomy: Surgery to remove the uterus, including the cervix Total hysterectomy with salpingo-oophorectomy: the uterus and cervix plus one ovary and fallopian tube are removed unilateral the uterus and cervix plus both ovaries and fallopian tubes are removed bilateral
Radical hysterectomy: The uterus, cervix, both ovaries, both fallopian tubes, plus part of the vagina, and nearby tissueare removed These procedures are done using a low transverse incision or a vertical incision Part of vagina
Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Treatment usually involves a combination of two or three chemotherapy drugs. This treatment may be considered in some cases, especially for those with stage 3 and 4 disease.
Chemotherapy also may be used in addition to surgery (called adjuvant therapy) to treat metastatic endometrial cancer and to prevent recurrent disease. Adjuvant chemotherapy for endometrial cancer is usually given for a total of six to eight 21-day cycles (the treatment is given once every 21 days for a total of six to eight treatments).
The following drugs are used to treat endometrial cancer: Carboplatin (Paraplatin®) Cisplatin (Platinol®) Doxorubicin (Doxil®) Cyclophosphamide (Cytoxin®) Paclitaxel (Taxol®, Paxene®)
RADIATION THERAPY Compared with low-risk endometrial cancer, intermediate-risk cancers have a higher chance of coming back after surgery. Intermediate-risk endometrial cancer has invaded more deeply into the lining of the uterus, or evidence of cancer invasion into the cervix when the hysterectomy specimen is examined under a microscope. Radiation therapy is recommended for some women after surgery. This practice is called "adjuvant" radiation therapy. The purpose is to get rid of any tumor cells that might be left in the body after surgery.
Adjuvant radiation therapy (RT) External beam RT Vaginal brachytherapy Low-dose rate brachytherapy uses a device that delivers radiation through the vagina continuously for two or three days, 24 hours per day. High-dose rate brachytherapy uses a device that delivers radiation in the vagina for only a few minutes at a time once a day, and treatment is generally repeated three to five times. This treatment is generally given as an outpatient and do not have to stay in the hospital overnight. During EBRT, your body is positioned beneath the X-ray machine in the same way every day, and the radiation field is exposed to the radiation beam for a few seconds once per day, five days per week, for five to six weeks. The choice between external beam RT and vaginal brachytherapy depends on a number of factors. However, for most women with intermediate-risk disease, vaginal brachytherapy seems to be as effective as external beam RT.
Hormone therapy Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.
Progestins The main hormone treatment for endometrial cancer Eg - medroxyprogesterone acetate (Provera®) and megestrol acetate (Megace®). Slowing the growth of endometrial cancer cells. Side effects can include increased blood sugar levels in patients with diabetes. Tamoxifen An anti-estrogen drug often used to treat breast cancer, may also be used to treat advanced or recurrent endometrial cancer. Prevent any estrogens circulating in the woman's body from stimulating growth of the cancer cellsand nourishing the cancer cells. It does not cause bone loss, but can cause hot flashes, vaginal dryness and increased risk of serious blood clots in the leg.
Gonadotropin-releasing hormone agonists These drugs switch off estrogen production by the ovaries in women who are premenopausal. Eg- goserelin (Zoladex) and leuprolide (Lupron). These drugs are injected every 1 to 3 months. Side effects can include hot flashes and vaginal dryness. If they are taken for a long time (years), these drugs can weaken bones (leading to osteoporosis). Aromatase inhibitors After the ovaries are removed estrogen is still made in fat tissue. Stop this estrogen from being formed and lower estrogen levels even further. Eg - letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). These drugs are most often used to treat breast cancer, but may be helpful in the treatment of endometrial cancer. Side effects can include joint and muscle pain and hot flashes. If they are taken for a long time (years), these drugs can weaken bones (leading to osteoporosis). These drugs are still being studied for use in treating endometrial cancer