Endometrial Cancer is a malignancy that arises from the lining of the uterus, endometrium.
It is the most common gynaelogical cancer in developing countries, while in developed countries it is the second most common cancer, behind cervical cancer.
• In year 2012 a total of 320,000 new cases were recorded.
• Globally, it is the sixth most common cancer in women, fourteenth most common overall.
• In Peninsular Malaysia, it is the seventh most common cancer in women, according to Malaysian cancer Registry 2006.
• It is rare among women younger than 40 years.
• Peak incidence occurring at age 60-69.
• Majority are of Chinese ethnicity (47.5%), followed by Malays (41.6%) and Indian (10.9%).
3. EPIDEMIOLOGY
• It is the most common gynaelogical cancer in developing countries,
while in developed countries it is the second most common cancer,
behind cervical cancer.
• In year 2012 a total of 320,000 new cases were recorded.
• Globally, it is the sixth most common cancer in women, fourteenth
most common overall.
• In Peninsular Malaysia, it is the seventh most common cancer in
women, according to Malaysian cancer Registry 2006.
• It is rare among women younger than 40 years.
• Peak incidence occurring at age 60-69.
• Majority are of Chinese ethnicity (47.5%), followed by Malays (41.6%)
and Indian (10.9%).
4. TYPES
• Type 1 (Endometrioid Carcinoma) is the most common (80%)
• Type 2 (Serous Carcinoma) is less common (20%)
TYPE 1
(Endometrioid Carcinoma)
TYPE 2
(Serous Carcinoma)
Age 50-60 70
Cause Related to estrogen Not related to estrogen
Risk Factor Obesity, DM, Late Menopause,
Nulliparity, Cancer, Unopposed
Estrogen, Tamoxifen, Family History
Atrophic endometrium/
polyp
Precursor Lesion Atypical endometrial hyperplasia Intraepithelial carcinoma
Example
Endometrioid Adenocarcinoma
Clear cell & papillary
carcinoma
Genetic PTEN mutation P53 mutation
Metastasis Lymph node, ovarian involvement Peritoneum
Prognosis Good Poor
5. RIK FACTOR
• Remember OLD AUNT
Type 1
Endometrioid
Carcinoma
Obesity
Late
Menopause
DM
Cancer
Unopposed
Estrogen
Nulliparity
Tamoxifen
6. • OBESITY
✓↑ body fat
✓↑ estrogen
✓↑ endometrial proliferation
• LATE MENOPAUSE
✓↑ menstrual cycles during a
woman's lifetime
✓↑ estrogen
✓↑ endometrial proliferation
• DM
✓insulin ↑ the growth of endometrial
stromal cells
• CANCER
✓hereditary nonpolyposis colorectal
cancer (HNPCC) syndrome
is caused by a germline mutation in
one of several DNA mismatch repair
(MMR) genes
✓Carriers of MMR gene mutations are
at increased risk of cancers of the
colon and endometrium
• UNOPPOSED ESTROGEN
✓Hormone replacement therapy in
postmenopausal women
✓↑ secretion due to androgen-
secreting tumor or stress
• NULLIPARITY (never gave birth)
✓↑ ovulation cycles
✓↑ estrogen
✓↑ endometrial proliferation
• TAMOXIFEN (drug for breast cancer)
✓it acts like an estrogen in the uterus
✓ ↑ estrogen
✓In women who have gone through
menopause, it can ↑ endometrial cell
growth
7. Type 2 Serous Carcinoma
Endometrial
Atrophy
Occurs in post menopausal women
Normally, when cells grow old or get
damaged, they die, and new cells take
their place.
Old or damaged cells however do not
die as they should.
The buildup of extra cells often forms a
mass of tissue called a growth or tumor.
Smoking
↑ progesterone
Endothelial cell
proliferation
8. PATHOGENESIS
• KEY WORDS
PROTOONCOGENE
• Involve in cell
differentiation and
proliferation
ONCOGENE
• Transform normal
cell into cancerous
cell
ANTIONCOGENE
• Suppress tumor cell
9. Both behave as a tumor suppressor gene
(antioncogene)
When mutated, loss of function
Activation of protooncogene & oncogene
Cancer cell formation
PTEN
• Located at
chromosome 10
P53
• Located at
chromosome 17
10. CLINICAL SYMPTOMS
Clinical Symptoms
Irregular vaginal bleeding, spotting, or discharge
Painful and difficulty during urination
Pain during sexual intercourse
Pelvic pain
Abdominal swelling due to the mass or due to fluid accumulation in the belly
(called ascites)
Persistent feeling of abdominal bloating with nausea or vomiting
Changes in bowel movements, such as constipation
Feeling full soon, after eating less
Loss of appetite with weight loss
Fatigue, feeling tired easily
Frequent urination (polyuria)
11. MORPHOLOGY
TYPE 1
(Endometrioid Carcinoma)
TYPE 2
(Serous Carcinoma)
Closely resemble normal endometrium Resembles ovarian serous carcinoma
May be exophytic, infiltrative or villoglandular
pattern
May have glandular pattern and resemble
villoglandular carcinoma on low power
Mucinous, tubular ciliated and squamous
(occasionally adenosquamous) differentiation.
Usually well formed papillae (thick and thin) or
tubules with "lobster claw" appearance
Is graded I to III, based on the degree of
differentiation
Usually a high grade tumor and behave
aggressively
Exhibits atypical hyperplasia Exhibits endometrial atrophy
Stroma present is usually desmoplastic
Usually marked desmoplastic response
resembling carcinosarcoma
May have foamy cells due to tumor necrosis Psammoma bodies
Tumor cells have moderate pleomorphism,
prominent nucleoli
Highly pleomorphic tumor cells containing
prominent nucleoli, small detached buds and
tufts
Atypia with no intervening stroma Exhibit much greater cytologic atypia
Vascular invasion is associated with chronic
inflammation around lymphatics
Prominent myometrial invasion, frequent
mitotic activity and necrosis
12. STAGING
• According to FIGO staging
Stage 1 – Cancer is confined to the body of the uterus
(corpus).
• 1A: <50% of uterus
1B: >50% of uterus
Stage 2 – Cancer has spread from the corpus to the cervix,
but not beyond the uterus
Stage 3 – Cancer has spread out locally/regionally3A:
Tumor invades the serosa and/or adnexa
• 3B: Vaginal and/or parametrial involvement
3C: Spread to pelvic and/or paraaortic lymph nodes
3C1: Pelvic lymph nodes only
3C2: Pelvic and/or paraaortic lymph nodes
Stage 4 – Cancer has spread to the bladder and/or bowel mucosa, or
beyond the pelvis to other parts of the body (distant metastasis)
• 4A: Tumor invades bladder and/or bowel mucosa
4B: Distant metastasis