SHRUTHI.S.JAYARAJ,53 RD
CALICUT MEDICAL COLLEGE
DEVELOPED COUNTRIES
DEVELOPING COUNTRIES

CA ENDOMETRIUM
CA CERVIX

 POOR HYGEINE
MULTIPARITY
EARLY MARRIAGE


INCIDENCE IS HIGHEST IN U.S, LOWEST IN
INDIA, JAPAN



PRIMARILY IN POST MENOPAUSAL LADIES

MEAN AGE ~ 60 yrs
OESTROGEN

RISK
FACTORS
OTHERS
OBESITY
DIABETES
HYPERTENSION
HNPCC


EXOGENOUS

HORMONE
REPLACEMENT
THERAPY

 TAMOXIFEN
FOR BREAST
CANCER

ENDOGENOUS
EARLY MENARCHE
LATE MENOPAUSE
PCO...
 HORMONE THERAPY FOR POST MENOPAUSAL

LADIES :
‘FEMININE FOREVER’ !!!

OESTROGEN USED ALONE
OESTROGEN + PROGESTINS

RISK
...


SERM
 POTENT ANTAGONIST IN BREAST – Rx of CA
BREAST
PARTIAL AGONIST IN UTERUS
LONG TERM USE- ENDOMETRIAL
PROLIFERATION...
 COMBINED ORAL HORMONAL PILLS HAVE A

PROTECTIVE EFFECT AND REDUSES RISK BY 4050%
 OBESITY REDUCES LEVEL OF

SERUM HORMONE BINDING
PROTEIN
FREE ESTROGEN
CIRCULATES IN BODY
 PERIPHERAL FAT : CONVERSION

...
 NULLIPAROUS WOMEN & WOMEN WITH PCOD

NON OVULATION
HIGH OESTROGEN

ENDOMETRIAL HYPERPLASIA ENDOMETRIAL
CANCER
NULLIPARITY

PCOS
EARLY MENARCHE
LATE MENOPAUSE

TAMOXIFEN
HRT

RISK
FACTORS

OBESITY
DIABETES

HYPERTENSION

LYNCH 2
/ HN...
 WOMEN WITH FAMILIAL LYNCH 2 SYNDROME

(HNPCC) ARE LIKELY TO SUFFER FROM
ENDOMETRIAL CANCER.
 TYPE 1

 TYPE 2
TYPE 1
 WELL
DIFFERENCIATED
 GLANDS BACK TO
BACK
 MINIMUM STROMA
TYPE 2
 POORLY
DIFFERENCIATED
 PREDOMINANTLY
SOLID PATTERN
 MINIMAL GLAND
FORMATION
55-65 YRS
OESTROGEN DEPENDANT
PREVIOUS H/O EXPOSURE TO UNOPPOSED
OESTROGEN.
a/w OBESITY/HYPERTENSION/DIABETES
‘WELL DIFFER...
65 – 75 yrs
OESTROGEN INDEPENDENT
UNRELATED TO HORMONE EXPOSURE
USUALLY ARISES IN AN ATROPHIC
ENDOMETRIUM
USUALLY UNDIFFER...
TYPE 1

TYPE 2

 55-65 YRS

 65 – 75 YRS

 ESTROGEN

 ESTROGEN

DEPENDENT
 ENDOMETRIAL
HYPERPLASIA MAY BE
PRESENT
 W...
TYPE 1

TYPE 2

 STABLE

 AGGRESSIVE

 MINIMAL MUSCLE

 DEEP MUSCLE

INVASION
 HISTOLOGY –
ENDOMETRIOD
 EXCELLENT
PR...
 ENDOMETRIAL CANCER MAY BE : LOCALISED/

DIFFUSE

APPEAR AS :

NODULE
POLYP
DIFFUSE LESION INVOLVING WHOLE
UTERINE CAVITY
DIFFUSE
 TO THE NAKED EYE THE ENDOMETRIAL

CURETTINGS APPEAR PALE & FRIABLE



HISTOLOGICALLY
75 % ADENOCARCINOMA
REST- SQUAMOUS...
GRADE 1 : WELL DIFFERENCIATED ADENO CARCINOMA
< 5 % SOLID GROWTH PATTERN
GRADE 2

:

MODERATELY DIFFERENCIATED
ADENOCARCIN...
GRADE 1

GRADE 2

GRADE 3
 ENDOMETRIOD
 MUCINOUS
 PAPILLARY SEROUS
 CLEAR CELL
 SQUAMOUS
 UNDIFFERENCIATED
 MIXED
 ENDOMETRIOD

GOOD PROGNOSIS

 MUCINOUS
 PAPILLARY SEROUS

 CLEAR CELL
 SQUAMOUS

BADPROGNOSIS
 COMMONEST TYPE ~ 80 %
 COMPOSED OF GLANDS WHICH RESEMBLE

NORMAL ENDOMETRIAL GLANDS
 WELL DIFFERENCIATED & GOOD PROGNO...
 5 % OF CANCERS
 HAVE A MUCINOUS PATTERN
 WELL DIFFERENCIATED GLANDULAR PATTERN
 GOOD PROGNOSIS
 5 % ALL TUMORS
 EXHIBIT PAPILLARY PATTERN
 BEHAVE AGGRESSIVELY
 POOR PROGNOSIS
 HIGH RISK FOR LYMPHOVASCULAR SPACE

...
 5 % OF ALL CANCERS
 CELLS LARGE WITH ATYPICAL NUCLEI,CLEAR

CYTOPLASM, CONTAIN GLYCOGEN
 MAY SHOW HOBNAIL CONFIGURATIO...
A

B

c
 VERY RARE VARIETY
 R/O SPREAD FROM CERVICAL SQUAMOUS

EPITHELIUM
 VERY POOR PROGNOSIS EVEN WITH STAGE 1
DISEASE
CLINICAL FEATURES
 ASYMPTOMATIC IN 7- 10 %
 MANIFEST AS

MENORRHAGIA & IRREGULAR PERIODS
PERIMENOPAUSAL LADIES
POST MENOPAUSAL BLEEDING IN...
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
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Endometrial carcinoma - SSJ,CALICUT MEDICAL COLLEGE

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ENDOMETRIAL CARCINOMA

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Endometrial carcinoma - SSJ,CALICUT MEDICAL COLLEGE

  1. 1. SHRUTHI.S.JAYARAJ,53 RD CALICUT MEDICAL COLLEGE
  2. 2. DEVELOPED COUNTRIES DEVELOPING COUNTRIES CA ENDOMETRIUM CA CERVIX  POOR HYGEINE MULTIPARITY EARLY MARRIAGE
  3. 3.  INCIDENCE IS HIGHEST IN U.S, LOWEST IN INDIA, JAPAN  PRIMARILY IN POST MENOPAUSAL LADIES MEAN AGE ~ 60 yrs
  4. 4. OESTROGEN RISK FACTORS OTHERS OBESITY DIABETES HYPERTENSION HNPCC
  5. 5.  EXOGENOUS HORMONE REPLACEMENT THERAPY  TAMOXIFEN FOR BREAST CANCER ENDOGENOUS EARLY MENARCHE LATE MENOPAUSE PCOS OBESITY FUNCTIONING OVARIAN TUMORS
  6. 6.  HORMONE THERAPY FOR POST MENOPAUSAL LADIES : ‘FEMININE FOREVER’ !!! OESTROGEN USED ALONE OESTROGEN + PROGESTINS RISK RISK
  7. 7.  SERM  POTENT ANTAGONIST IN BREAST – Rx of CA BREAST PARTIAL AGONIST IN UTERUS LONG TERM USE- ENDOMETRIAL PROLIFERATION,CARCINOMA
  8. 8.  COMBINED ORAL HORMONAL PILLS HAVE A PROTECTIVE EFFECT AND REDUSES RISK BY 4050%
  9. 9.  OBESITY REDUCES LEVEL OF SERUM HORMONE BINDING PROTEIN FREE ESTROGEN CIRCULATES IN BODY  PERIPHERAL FAT : CONVERSION OF EPIANDROSTENEDIONE TO OESTRONE
  10. 10.  NULLIPAROUS WOMEN & WOMEN WITH PCOD NON OVULATION HIGH OESTROGEN ENDOMETRIAL HYPERPLASIA ENDOMETRIAL CANCER
  11. 11. NULLIPARITY PCOS EARLY MENARCHE LATE MENOPAUSE TAMOXIFEN HRT RISK FACTORS OBESITY DIABETES HYPERTENSION LYNCH 2 / HNPCC
  12. 12.  WOMEN WITH FAMILIAL LYNCH 2 SYNDROME (HNPCC) ARE LIKELY TO SUFFER FROM ENDOMETRIAL CANCER.
  13. 13.  TYPE 1  TYPE 2
  14. 14. TYPE 1  WELL DIFFERENCIATED  GLANDS BACK TO BACK  MINIMUM STROMA
  15. 15. TYPE 2  POORLY DIFFERENCIATED  PREDOMINANTLY SOLID PATTERN  MINIMAL GLAND FORMATION
  16. 16. 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 CARCINOMA EXCELLENT PROGNOSIS
  17. 17. 65 – 75 yrs OESTROGEN INDEPENDENT UNRELATED TO HORMONE EXPOSURE USUALLY ARISES IN AN ATROPHIC ENDOMETRIUM USUALLY UNDIFFERENCIATED & AGGRESSIVE DEEP MUSCLE INVASION BAD PROGNOSIS
  18. 18. TYPE 1 TYPE 2  55-65 YRS  65 – 75 YRS  ESTROGEN  ESTROGEN DEPENDENT  ENDOMETRIAL HYPERPLASIA MAY BE PRESENT  WELL DIFFERENCIATED INDEPENDENT  USUALLY IN ATROPHIC ENDOMETRIUM  UNDIFFERENCIATED
  19. 19. TYPE 1 TYPE 2  STABLE  AGGRESSIVE  MINIMAL MUSCLE  DEEP MUSCLE INVASION  HISTOLOGY – ENDOMETRIOD  EXCELLENT PROGNOSIS INVASION  HISTOLOGY- SEROUS / CLEAR CELL  BAD PROGNOSIS
  20. 20.  ENDOMETRIAL CANCER MAY BE : LOCALISED/ DIFFUSE APPEAR AS : NODULE POLYP DIFFUSE LESION INVOLVING WHOLE UTERINE CAVITY
  21. 21. DIFFUSE
  22. 22.  TO THE NAKED EYE THE ENDOMETRIAL CURETTINGS APPEAR PALE & FRIABLE  HISTOLOGICALLY 75 % ADENOCARCINOMA REST- SQUAMOUS / SEROUS
  23. 23. 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
  24. 24. GRADE 1 GRADE 2 GRADE 3
  25. 25.  ENDOMETRIOD  MUCINOUS  PAPILLARY SEROUS  CLEAR CELL  SQUAMOUS  UNDIFFERENCIATED  MIXED
  26. 26.  ENDOMETRIOD GOOD PROGNOSIS  MUCINOUS  PAPILLARY SEROUS  CLEAR CELL  SQUAMOUS BADPROGNOSIS
  27. 27.  COMMONEST TYPE ~ 80 %  COMPOSED OF GLANDS WHICH RESEMBLE NORMAL ENDOMETRIAL GLANDS  WELL DIFFERENCIATED & GOOD PROGNOSIS
  28. 28.  5 % OF CANCERS  HAVE A MUCINOUS PATTERN  WELL DIFFERENCIATED GLANDULAR PATTERN  GOOD PROGNOSIS
  29. 29.  5 % ALL TUMORS  EXHIBIT PAPILLARY PATTERN  BEHAVE AGGRESSIVELY  POOR PROGNOSIS  HIGH RISK FOR LYMPHOVASCULAR SPACE INVOLVEMENT AND DEEP MYOMETRIAL INVASION EVEN WITH EARLY STAGE DISEASE  SPREAD EARLY TO ABDOMEN
  30. 30.  5 % OF ALL CANCERS  CELLS LARGE WITH ATYPICAL NUCLEI,CLEAR CYTOPLASM, CONTAIN GLYCOGEN  MAY SHOW HOBNAIL CONFIGURATION AND FORM PAPILLARY STRUCTURES  HIGHLY AGGRESSIVE  BAD PROGNOSIS
  31. 31. A B c
  32. 32.  VERY RARE VARIETY  R/O SPREAD FROM CERVICAL SQUAMOUS EPITHELIUM  VERY POOR PROGNOSIS EVEN WITH STAGE 1 DISEASE
  33. 33. CLINICAL FEATURES
  34. 34.  ASYMPTOMATIC IN 7- 10 %  MANIFEST AS MENORRHAGIA & IRREGULAR PERIODS PERIMENOPAUSAL LADIES POST MENOPAUSAL BLEEDING IN MENOPAUSAL WOMAN
  35. 35. ELDERLY WITH CERVICAL STENOSIS HAEMATOMETRA/PYOMETRA PURULENT VAGINAL DISCHARGE
  36. 36.  SOME WOMEN EXPERIENCE PELVIC PRESSURE AND PAIN DUE TO UTERUS ENLARGEMENT OR EXTRAUTERINE SPREAD
  37. 37.  ADVANCED STAGE- BULKY CERVIX, GROWTH PROTRUDING THROUGH OS
  38. 38. THANK YOU
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