Endometrial cancer arises from the lining of the uterus. The major risk factors include increased estrogen exposure unopposed by progesterone, obesity, and hereditary nonpolyposis colorectal cancer. Symptoms include abnormal uterine bleeding, especially in postmenopausal women. Diagnosis is made by endometrial biopsy, which is recommended for women with risk factors or abnormal bleeding. Most cases are diagnosed early and treated with hysterectomy and radiation, resulting in high survival rates.

1. Ca uterus

2. • Endometrial cancer arises from the lining of
the endometrium.
• Most tumors are adenocarcinomas.
• The precursor may be a hyperplastic state that
progresses to invasive carcinoma.
• Hyperplasia occurs when estrogen is not
counteracted by progesterone.

3. • Cancer of the endometrium is the most common
gynecologic malignancy.
• Approximately 47,000 newly diagnosed cases of
endometrial cancer and 8000 deaths occur
annually.
• Endometrial cancer has a relatively low mortality
rate, since most cases are diagnosed early.
• The survival rate is over 95% if the cancer has not
spread at the time of diagnosis

4. Etiology and Pathophysiology
• The major risk factor for endometrial cancer is
estrogen, especially unopposed estrogen.
• Additional risk factors include
increasing age, nulliparity, late menopause, obesity,
smoking, diabetes mellitus, and a personal or family
history of hereditary
• nonpolyposis colorectal cancer (HNPCC)
• Obesity is a risk factor because adipose cells store
estrogen, thus increasing endogenous estrogen.

5. • The cancer directly extends into the cervix and
through the uterine serosa.
• As invasion of the myometrium occurs, regional
lymph nodes, including the paravaginal and para-
aortic, become involved.
• Hematogenous metastases develop concurrently.
• The usual sites of metastases are lung, bone,
liver, and eventually the brain.
• Malignant cells can be found in the peritoneal
cavity, probably after transport through the
fallopian tubes

6. • Prognostic factors include histologic
differentiation, myometrial invasion,
peritoneal cytology, lymph node and adnexal
metastases, and tumor size.
• Endometrial cancer grows slowly,
metastasizes late, and is curable with therapy if
diagnosed early.

7. Clinical Manifestations
• The first sign of endometrial cancer is
abnormal uterine bleeding, usually in
postmenopausal women.
• it is important that this sign not be ignored or
attributed to menopause.
• Pain occurs late in the disease process.
• Other manifestations that may arise are
related to metastasis to other organs.

8. • Metastatic spread occurs in a characteristic
pattern.
• Spread to the pelvic and paraaortic nodes is
common.
• When distant metastasis occurs, it most
commonly involves the lungs, liver, bones,
brain, and vagina

9. Diagnostic measures
• Endometrial biopsy is the primary diagnostic test for
endome-
trial cancer.
• Endometrial biopsy is done on an outpatient basis.
• Any abnormal or unexpected bleeding in a postmenopausal
woman requires obtaining a tissue sample to exclude
endometrial cancer.
For women who have or are at risk of developing HNPCC, the
American Cancer Society recommends annual screening with
endometrial biopsy beginning at 35 years of age.
• The Pap test is not a reliable diagnostic tool for endometrial
cancer, but it can rule out cervical cancer

10. • Most cases of endometrial cancer are diagnosed
at an early stage when surgery alone may result
in cure.
• Treatment of endometrial cancer is a total
hysterectomy and bilateral salpingo-
oophorectomy with lymph node biopsies.
• The lack of estrogen and progesterone receptors
is a poor prognostic indicator.
• Surgery may be followed by radiation, either to
the pelvis or the abdomen externally or
intravaginally, to decrease local recurrence

11. • No tumor markers with high sensitivity and
high specificity for endometrial cancer are
known at present, although CA-125 is often
used in clinical practice.
• CA-125 has been used in surveillance of
advanced endometrial cancer.
• In patients who have increased CA-125 values
pretreatment, this test might prove
useful in post treatment surveillance.

12. • Treatment of advanced or recurrent disease is
difficult.
• Progesterone HT (e.g., megestrol [Megace]) can
be used when the progesterone receptor status is
positive and the tumor is well differentiated.
• Tamoxifen (Nolvadex), either alone or in
combination with progesterone therapy, is also
effective in women with advanced or recurrent
endometrial cancer.

13. • Chemotherapy is considered when
progesterone therapy is unsuccessful.
• Agents used include doxorubicin (Adriamycin),
cisplatin (Platinol), 5-fluorouracil (5-FU),
carboplatin (Paraplatin), and paclitaxel
(Taxol)