1. Endometrial cancer is the most common gynecological cancer in postmenopausal women, with risk factors including obesity, late menopause, and exposure to unopposed estrogen. 2. Diagnosis involves endometrial biopsy and staging involves assessing the extent of spread. Surgery is the primary treatment and radiation is added for more advanced cases. 3. Prognosis depends on staging, grade, and extent of invasion, with 5-year survival rates ranging from 85% for stage 1 to 42% for stage 3. Recurrence within 5 years occurs in about 30% of cases.

1. pre se nt ed by:
$$ICOG,
Dr. Rozhan Yassin khalil
ABOG,HDOG,FI S,MBChB
20

2. LIAR INOMA FNDOMETRIUM:
One of the commonest gynecological
cancers especially in white Americans.
is a disease of postmenopausal
women with a peak incidence in the
6'h 7th decade of life
it occurs most often in postmenopausal
up to %of cases with less
women
than
age.
diagnosed under 40 years of

3. UTERUS WITH ADFNOCARCINOMA THE
FNDOMETRIUM.

4. CREENING:
There is no effective screening
programme,
but occasionally cervical smears
endometrial cancer cells
or double thickness endometrial
ultrasonic thickness of 4mm or more
indicates a need for endometrial

5. RISK FACTORS ENDOMETRIAL CA.
lv The actual cause
of this cancer is
unknown
3. Estrogen secreting (idiopathic).
tumors of the ovary are
associated with an
increased incidence of
endometrial
carcinoma.
given estrogen alone as
postmenopausal hormone
replacement therapy .
. -Early menarche
<l2Y
Late menopause >
52 Y
Estrogen

6. RIsK TRACTORS:
4.Nolliparity and PCO
syndrome with defective
progesterone synthesis ) carry
an increased risk.
5. obese› diabetic and
hypertensive women
develop endometrial
cancer.
6. risk in women
with breast, ovarian
(endometrial type) &
colorectal Ca.
8.Family of
endometrial
7.Previous pelvic
radiation therapy

7. RISK TRACTORS:
The endometrial hyperplasia induced
by Tamoxife produces endometrial
polyp suggested a four-fold increase in
endometrial carcinoma.

8. RISK FACTORS FOR ENDOMETRIAL
CANCER:
• Obesity
• Impaired carbohydrate tolerance
• Nulliparity
• Late menopause
• Unopposed oestrogen therapy
• Functioning ovarian tumours
• Previous pelvic irradiation
• Family history of carcinoma of breast,
ovary or colon

9. PROTECTION FOR ENDOMETRIAL J7$.
contraception, especially after
term use.reduces incidence of both
endometrial and ovarian carcinomas).
Cigarette smoking has also been
associated with the reduced risk
endometrial cancer.

10. SYMPTOMATOLOGY:
The usual presenting symptom of endometrial
carcinoma is :
1.postmenopausal bleeding which carries a
10 $dJ risk of associated malignancy in the
absence of hormone replacement therapy.
Curettage. or endometrial sampling is
mandatory.
2. Postmenopausal discharge from
pyometra carries a 50% risk of associated
malignancy.
3.Pain may occur with pyometra or
metastatic spread.

11. DIAGNOSIS:
l-Hysteroscopy with endometrial curettage
2-endometrial sampling.
curettage alone›
outpatient endometrial sampling alone. are
essential.
Curettage is not infallible. the other hand.
if a Pipette has been correctly introduced
the pathology is benign, or no tissue is
obtained , it is most unlikely that
malignancy exists.

12. DIAGNOSIS:
Hysteroscopy cervical smear
risk of concurrent cervical
malignancy and
abdominal
ultrasound for
pathology are advised when
found.
endometrial malignancy

14. Typical early polypoidal
fundal gro h
oftumor (60%)arepureadenocucinomatz.
groupsaccordingtoie degreeofgl dulardifferentiation.
canbedividedinto

15. Single ¿—”
cell *”
columns
Gmde 1 well differentiated.
Gland forms are conspicuous. Mitotic
figures are moderately numerous.
Crude 2 patchy differentiation.
Gland forms are much less prominent
and many deposits consist of
izzAItmt?ng single celt cotuznn5
or solid maeses.
Grade 3. This type consists of solid
masses of malignant cells of varying
sizes and shapes with little or no stroma.
Mitoses are numerous.

16. HISTOPATH :
60 70
10-20O
Jo
0%.
1-Adenocarcinomas
Adenosquamous Cia
Serous
Clear cell
Mucinous C!a
Secretory
Squamous cell
rare
9%.
-2%.
extremely

17. Clear ce3ed carcinoma
This tumow hasa poor
and is
included theGrade
3 adenocarcinomata. It
occurs mainly in the
elderly.

21. holded
) 0f bladderor
stiictuei beyond pelńs.
Histological or isappliedtoSaøeSI, ind only.

22. READ :
In general this cancer is slow to
spread from the uterine cavity,
probably because the endometrium
lacks lymphatics.
chest X—ray helps detect
metastases.
Magnetic resonance imaging is
preferable to ultrasound for
detection of myometrial invasion and
pelvic spread.

24. VENOUS SPREAD:
Venous Spread
This pathway might account for
the occasional appearance of
low vaginal metastasis;
but venous spread is
common feature of
cancer.
not
uterine

25. LYMPHATIC ÍÑPREAD:
Lymphatic Spread
The incidence of this seems to be
between 10 and 30%.
All pelvic nodes, including the internal
iliacs, the parametrium, the ovaries, and
the vagina may be involved, probably with
equal frequency.
Lymphatic spread is more likely to
occur when the tumour is anaplastic and
the uterine wall is deeply invaded. „,

26. TUBAL SPREAD•
Tubal Spread
Malignant cells can along the
tube in the same way that peritoneal
may occur during menstruation.
This may account for isolated
ovarian metastases.

27. Tubal metastases
Lateral
pelvic
Para aortic Ellands
Vaginal
metastasis
Internal iliac glands
Original
Local vaginal
spread
Ovarian
Most metastases occur in adjacent structures and peritoneum. In advanced cases distant
metastases do occur, most commonly in lung, but occasionally in liver, vertebrae or other
bones and in supraclavicular lymph nodes.

28. ROGNOSIS OF
ENDOMETRIAL CARCINOMA
With the exception of stage tumors of
histological grades and II, the prognosis
is less favourable than many gyaeeologists
believe.
with an overall year survival of 70
approximately.
Fortunately over 80 %of cases are
diagnosed at stage

29. PROGNOSTI FACTORS:
.Staging diagnosis,
extent of myometrial invasion .
histological grading(differentiation).
are the most important
factors apart from competence
treatment.

30. Stage ye survival
85%
68%
42

31. TREATMENT OF ENDOMETRIAL
CARCINOMA
This is essentialy surgiCal, with
postoperative radiotherapy added
when :
.unfavourable prognostic features are
found at surgery ,
2.Pre-operative clinical
inaccurate.
.
lS
Progestogen therapy is probably only of
value in recurrent disease.

32. $OOMEN UN FIT FOR
Few women are
and caesium insertion
surgery,
radioactive therapy may be
employed for these,
but alone is less
effective than combined
and radiation treatment.

33. ÍÑTAGF :(TREATMENT)
Total abdominal hysterectomy
and bilateral
oophorectomy without
removal of
Peritoneal saline washings are taken
for on opening the
abdomen and the Abdominal
contents carefully examined.

34. STAGE
Stage Ha carries a similar prognosis
to Stage I and may be treated as stage
Stage IIb with clinical invasion of the
cervix. has a poorer prognosis than
Stage I and radical hysterectomy.
pelvic lymphadenectomy and para-aortic
lymph node sampling are indicated.
with a combination of local and external
radio therapy as an alternative
treatment.

35. STAGE
Following the Staging
radical hysterectomy,
lymphadenectomy,
node and removal as
much malignant tissue as
omentectorny is carried
possible,
out.
Stage
pelvis
diseases limited to the
be treated by
radiotherapy

36. STAGE
Treatment of this Stage is designed
to control tumour growth and
alleviate symptoms.
Surgery, radiation therapy,
therapy and
adj progestogen therapy
all have a place.

37. CARCINOMA OF THE FNDOMFTRIUM
COMPARED WITH CA CERVIX:
The overall results are better than
for carcinoma of the cervix, not
because it is less malignant tumour,
but because treatment is usually
given earlier.
Post menopausal bleeding is
much more difficult to ignore than
the irregular bleeding of the younger
woman.

38. RECURRENCE OF ENDOMETRIAL
CARCINOMA
The incidence of recurrence within 5years is
in the region of 30%and is accepted along
with the 5-year survival rate as a measure of
the effectiveness of the various systems of
treatment.
The majority recurrences appear
within 3 years of treatment. Early
recurrence has a poor Prognosis.

39. PROGESTOGENS.
Many endometrial carcinomata are
hormone dependent and progestogens
have been used as a combined
treatment , recurrent or
metastatic growths.
Between 15 and 50 %of recurrences will
respond. Medroxyprogesterone acetate›
400 to 600 daily

40. HEMOTHERAPY:
Chemotherapy
chemotherapy has a limited place
in advanced recurrence.
Single agent therapy with adriamycin,
cisplatinum ,cyclophosphamide gives
response rates between 20 and 40