Endometrial ca by Dr noor muhammad

2. NOOR MUHAMMAD WAZIR
08-143
BATCH: I
FINAL YEAR MBBS
GYNAE:C

3. ENDOMETRIAL
CARCINOMA

4. ANATOMY OF UTERUS
GROSS HISTOLOGIC

5. ENDOMETRIAL HYPERPLASIA
 A spectrum of proliferative
abnormalities of
endometrium are
subdivided into:
 CYSTIC HYPERPLASIA:
increase in the number of
glands.
 ADENOMATOUS
HYPERPLASIA: back to
back crowding of glands
with little intervening
stroma.
 ATYPICAL
HYPERPLASIA: glands
show nuclear

6. CAUSES AND RISK FACTORS
OF ENDOMETRIAL CARCINOMA

7. EFFECTS OF ESTROGEN ON ENDOMETRIUM

8. M

 Other causes :
 Myomas
 Senile endometritis
 Dietary factors

10. PATHOLOGY
GROSS FEATURES:
DIFFUSE TYPE:
Involves most of endometrium. May
reach the myometrium and serous
surface.
PYOMETRA:
uterus is enlarged due to the
formation of pyometra which is
formed following an infection of the
tumor with accumulation of pus due to
stenosis of internal cervical os
LOCALIZED TYPE:
It is limited to small area where it
forms a polypoidal growth. polyp is
friable, ulcerated and necrosed.

11. MICROSCOPIC FEATURES:
1.Adenocarcinoma(ca. arising from glandular tissue)
2.adenocanthoma.
3.Adenosquamous carcinoma
Histological grading of adenocarcinoma depends upon degre
of differentiation.
GRADE 1: <5% non squamous
Well differentiated
GRADE 2: < 6-50% non squamous
moderately differentiated
GRADE 3: >50% non squamous
undifferentiated

12. SPREAD
 DIRECT:
 Cervical canal: here the tumor may get infected and blocks the Cervix
leading to pyometra formation
 Myometrium
 Ovaries
 LYMPHATIC SPREAD:
 inguinal lymph nodes
 para aortic lymph nodes.
 BLOOD BORNE:
 Lungs,
 Liver,
 Bone etc
 IMPLANTATION:
 During hysterectomy malignant cells may get implanted in the vaginal vault
causing recurrence.

13. CLINICAL FEATURES
 SYMPTOMS
BLEEDING: due to ulceration and sloughing
off of the carcinoma.
 Irregular vaginal bleeding.
 Post menopausal bleeding.
 MENORHAGIA in premenopausal patients.
 VAGINAL DISCHARGE:
 Brownish or blood stained, offensive or
purulent due to pyometra.

14.  PAIN: late symptom.
 Indicates advanced growth with metastasis.
 Dull, colicky lower abdominal pain.
 Occurs due to strong contractions of uterus to
expel the polypoid growth or pyometra.
 ASYMPTOMATIC

15. PHYSICAL
EXAMINATION
 Palpation of
supraclavicular and
groin nodes.
 Breast is examined for
a co-existent primary or
secondary lesion.
 Speculum
examination: done for
metastatic invasion of
vagina.in case of
pyometra a pyogenic or
blood stained discharge
pours from the cervix.

16. BIMANUAL PELVIC
EXAMINATION:
 To assess the
size,consistency
and mobility of
uterus.
 Findings: large
size,
 soft consistency in
case of pyometra
 Reduced mobility if
the tumor has
extended beyond

17. CLINICAL STAGING

19. DIAGNOSTIC TECHNIQUES
 ENDOMETRIAL SAMPLING:
 Fractional curettage: The endometrial curetting are bulky and
necrotic.

20. HYSTEROSCOP
Y:
Extent of the
disease and site of
invasion can be
biopsied easily

21. TRANSVAGINAL
ULTRASOUND(TVS):
Uterine enlargement
Thick hyper echoic
endometrial lining.
Loss of
subendometrial halo in
case of myometrial

22. CERVICAL SMEAR:
RADIOLOGICAL
EXAMINATIONS:
X-RAY CHEST,MRI, IVU

23.  TUMOUR MARKERS:
 CA-125 is a non specific tumor marker. Patients with
clinical stage 4 disease show raised levels.
 OTHER TESTS:
 CBC
 Blood group
 Blood sugar level
 Serum creatinine
 Urea
 Electrolytes
 ECG

24.  GENERAL
MEASURES
 SURGERY
 SURGERY AND
RADIOTHERAPY
 CHEMOTHERAPY
According to the stage
of the disease
TREATMENT

25. GENERAL MEASURES
 General health should be improved
 LFTs
 RFTs
 Blood glucose

26. STAGE TREATMENT PLAN
STAGE 1a grade 1 TAH/BSO
OTHER STAGE 1 TAH/BSO,radiotherapy
STAGE 2 radical hysterectomy/BSO ,pelvic
lymphadenectomy radiotherapy
STAGE 3 Radiotherapy:if only pelvis is
involved
Laparotomy;if disease spreads
beyond
pelvis(omentectomy,lymphadenecto
my)
STAGE 4 radiotherapy,chemotherapy,debulki
ng surgery,hormonal therapy

27. FIVE YEAR SURVIVAL RATES
STAGE RATES
1 82-86%
2 70%
3 40%
4 16-27%

28. SURGICAL OPTIONS

30. RADIOTHERAPY OPTIONS
 COMBINED WITH SURGERY:
 Treatment of choice for stage 1C or stage 2 in which
more than half of the myometrium and cervical
glands and stroma are involved.
 RADIOTHERAPY ALONE:
 If the growth is wide spread in the pelvis(stage 3,4)
or if the patient is too weak to undergo surgery.
 ROUTES:
 BRACHYTHERAPY:intracavitary
 TELETHERAPY:by external routes

31. CHEMOTHERAPY OPTIONS
 PROGESTOGEN:
 For relief of pain in advanced cases.
 2-3 injections are given before or after
surgery or radiotherapy.
 Minimum duration of treatment is more
than 3 months.
 PREPARATIONS:
 Inj.medroxyprogesterone acetate 200
mg im weekly(depoProvera)
 Inj.hydroxyprogesterone caproate 250
mg im weekly(proluton Depot)
 Tab.norethisterone10 mg tid.(primolute

32. FOLLOW UP
 TO DETECT THE RECURRENCE:
 Vaginal recurrence is common so it should be examined
at every visit.
 TO DETECT COMPLICATIONS OF THERAPY:
 Hematuria,
 Cystitis,
 Diarrhea,
 Melena
 Rectal spasm,
 Ilietus,
 Vaginal stenosis,
 Lymphedema etc