nursing

1. ENDOMETRIAL CANCER
DEFINITION
Endometrial carcinoma:- Endometrial cancer starts when cells in the
endometrium (the inner lining of the uterus) start to grow out of control. Cells in
nearly any part of the bodycan become cancer, and can spread to other parts of the
body.
INCIDENCE
the incidence is higher among this to the white population of United States and
lowest in India and Japan.
North America the White, carcinoma bodyis the leading site of genital malignancy
followed by ovary and cervix.
In USA a woman has about 1% chance of developing endometrial carcinoma
during her lifetime. In India , it ranks third amongest the genital malignancy next
to cervix and ovary .
AETIOLOGY
The following are found to be related to carcinoma bodyof the uterus
 Oestrogen- persistent stimulation of endometrium with unopposed oestrogen
most important factor for the development of endometrial cancer.
 Age -about 75% are postmenopausalwith a median age of 60.
About 10% of women with postmenopausalbleeding have endometrial
cancer.
 Parity- it is quite commonin unmarried and in married ,nulliparity is
associated in about 30 percent.
 Late menopause – the chance of carcinoma increase ,if menopause fails to
occurbeyond 52 years.
 Corpus cancer syndrome- encompasses obesity , hypertension and diabetes.
 Obesity- leads to high level of free oestradiol as the sex hormones binding
globulin level is low.

2.  Unopposed oestrogenstimulation-is a condition suchas functioning ovarian
tumors or PCOS is associated with increased risk of endometrial cancer.
oestrogen replacement therapy in postmenopausal is at high risk.
 Tamoxifen is antioestrogenic as well as weakly oestrogenic .it is used for
treatment for the breast cancer.
 Family history or personal history of colon ovarian or breast cancer increase
the risk of endometrial cancer.
 Fibroid- is associated in about 30%cases.
 Endometrial hyperplasia preceds carcinoma in about 25%cases
PATHOLOGY
Nakedeye-the uterus mein do smaller, normal work even enlarged two varieties
are found:
 Localised- the usual site is on the fundus. It is either sessile or pedunculated.
Myometrial involvement is late.
 Diffuse- the spread is through the endometrium. The myometrium is
commonly invaded ; may invade to reach serosalcoat.
Microscopicappearance
The following varieties are noted:
 Adenocarcinoma
 Adenocanthoma
 Papillary carcinoma
 Clear cell adenocarcinoma
 Mucinous adenocarcinoma
 Squamous cell carcinoma
 Mixed carcinoma
SPREAD
Direct - it is confined to the stroma for a long time but it spreads in all directions it
may infiltrate the mind and spread to the parametrium into the peritoneal cavity
downwards to involve the service in about 15%

3. Lymphatic- the Olympics played is usually late lymphatic system involve
paraarotic and rarely inguninaland femoral lymph node.
Bloodborne- bloodbornespread occurlate the common site of metastasis lungs ,
liver,bone and brain.
STAGING
GRADING ENDOMETRIALCANCER
The grade of an endometrial cancer is based on how much the cancer cells are
organized into glands that look like the glands found in a normal, healthy
endometrium.
 Grade 1 tumors have 95% or more of the cancer tissue forming glands.
 Grade 2 tumors have between 50% and 94% of the cancer tissue forming
glands.

4.  Grade 3 tumors have less than half of the cancer tissue forming glands.
Grade 3 cancers tend to be aggressive (they grow and spread fast) and have a
worse outlook than lower-grade cancers.
SIGN AND SYMPTOMS
 Vaginal bleeding or discharge not related to menstruation (periods).
 Vaginal bleeding after menopause.
 Difficult or painful urination.
 Pain during sexual intercourse.
 Pain in the pelvic area.
INVESTIGATION
 History
Endometrial cancer presents as postmenopausalbleeding (PMB) and,
although this is not the only cause, it must be excluded. Abnormal uterine
bleeding is the presenting symptom in 90% of cases. It may also present
around or before the menopause in about 20-25% of cases with irregularities
of the menstrual cycle.
 Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries,
and rectum. A speculum is inserted into the vagina and the doctor
or nurse looks at the vagina and cervix for signs of disease. A Pap test of the
cervix is usually done. The doctoror nurse also inserts one or two lubricated,
gloved fingers of one hand into the vagina and places the other hand over the
lower abdomen to feel the size, shape, and position of the uterus and ovaries.
The doctorornurse also inserts a lubricated, gloved finger into the rectum to
feel for lumps or abnormal areas.
 Chestx-ray
An x-ray of the organs and bones inside the chest. An x-ray is a type of
energy beam that can go through the bodyand onto film, making a picture
of areas inside the body.
 (CAT scan)

5. A procedurethat makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made by a computer
linked to an x-ray machine. A dye may be injected into a vein or swallowed
to help the organs or tissues show up more clearly. This procedureis also
called computed tomography, computerized tomography, or computerized
axial tomography.
 MRI (magnetic resonanceimaging)
A procedurethat uses a magnet, radio waves, and a computer to make a
series of detailed pictures of areas inside the body. This procedureis also
called nuclear magnetic resonance imaging (NMRI).
 PET scan(positron emissiontomography scan)
A procedureto find malignant tumor cells in the body. A small amount
of radioactive glucose (sugar) is injected into a vein. The
PET scanner rotates around the bodyand makes a picture of where glucose
is being used in the body. Malignant tumor cells show up brighter in the
picture becausethey are more active and take up more glucose than normal
cells do.
 Lymph node dissection
A surgical procedurein which the lymph nodes are removed from
the pelvic area and a sample of tissue is checked under a microscopefor
signs of cancer. This procedure is also called lymphadenectomy.
 Transvaginal ultrasound exam
A procedureused to examine the vagina, uterus, fallopian tubes,
and bladder. An ultrasound transducer (probe) is inserted into the vagina and
used to bounce high-energy sound waves (ultrasound) off internal tissues or
organs and make echoes. The echoes form a picture of bodytissues called
a sonogram. The doctorcan identify tumors by looking at the sonogram
 Endometrial biopsy
The removal of tissue from the endometrium (inner lining of the uterus) by
inserting a thin, flexible tube through the cervix and into the uterus.
 Dilatation and curettage
A procedureto remove samples of tissue from the inner lining of the uterus.
The cervix is dilated and a curette (spoon-shaped instrument) is inserted into
the uterus to remove tissue. The tissue samples are checked under a
microscopefor signs of disease. This procedureis also called a D&C.

6.  Hysteroscopy
A procedureto look inside the uterus for abnormal areas. A hysteroscopeis
inserted through the vagina and cervix into the uterus. A hysteroscope is a
thin, tube-like instrument with a light and a lens for viewing. It may also
have a tool to remove tissue samples, which are checked under a microscope
for signs of cancer.
TREATMENT
1-Surgery
Surgery (removing the cancer in an operation) is the most common treatment for
endometrial cancer. The following surgical procedures may be used:
 Total hysterectomy: Surgery to remove the uterus, including the cervix. If
the uterus and cervix are taken out through the vagina, the operation is called
a vaginal hysterectomy. If the uterus and cervix are taken out through a
large incision (cut) in the abdomen, the operation is called a
total abdominal hysterectomy. If the uterus and cervix are taken out through
a small incision (cut) in the abdomen using a laparoscope, the operation is
called a total laparoscopic hysterectomy.
 Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and
both fallopian tubes.
 Radical hysterectomy: Surgery to remove the uterus, cervix, and part of the
vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be
removed.
 Lymph node dissection: A surgical procedurein which the lymph nodes are
removed from the pelvic area and a sample of tissue is checked under
a microscopefor signs of cancer. This procedure is also called
lymphadenectomy.
2-Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types
of radiation to kill cancer cells or keep them from growing.
There are two types of radiation therapy:

7.  External radiation therapy uses a machine outside the bodyto send radiation
toward the cancer.
 Internal radiation therapy uses a radioactive substancesealed in needles, seeds,
wires, or catheters that are placed directly into or near the cancer.
3-Chemotherapy
o Chemotherapy is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping the cells from dividing.
When chemotherapy is taken by mouth or injected into a vein or muscle, the
drugs enter the bloodstream and can reach cancer cells throughout the body
(systemic chemotherapy).
o When chemotherapy is placed directly into the cerebrospinal fluid, an organ,
or a bodycavity suchas the abdomen, the drugs mainly affect cancer cells in
those areas (regional chemotherapy).
The way the chemotherapy is given depends on the type and stage of the cancer
being treated.
4-Hormonetherapy
Hormone therapy is a cancer treatment that removes hormones or blocks their
action and stops cancercells from growing. Hormones are substances made
by glands in the bodyand circulated in the bloodstream. Some hormones can cause
certain cancers to grow. If tests show that the cancer cells have places where
hormones can attach (receptors), drugs, surgery, or radiation therapy is used to
reduce the productionof hormones or block them from working.
5-Targetedtherapy
Targeted therapy is a type of treatment that uses drugs or other substances to
identify and attack specific cancer cells without harming normal cells. Monoclonal
antibodies, mTOR inhibitors, and signal transduction inhibitors are three types of
targeted therapy used to treat endometrial cancer.
 Monoclonal antibody therapy is a cancer treatment that uses antibodies made
in the laboratory from a single type of immune system cell. These antibodies
can identify substances on cancer cells or normal substances that may help
cancer cells grow. The antibodies attach to the substances and kill the cancer
cells, block their growth, or keep them from spreading. Monoclonal antibodies

8. are given by infusion. They may be used alone or to carry drugs, toxins, or
radioactive material directly to cancer cells. Bevacizumab is used to treat stage
III, stage IV, and recurrent endometrial cancer.
 mTOR inhibitors block a protein called mTOR, which helps control cell
division. mTOR inhibitors may keep cancer cells from growing
and prevent the growth of new blood vessels that tumors need to
grow. Everolimus and ridaforalimus are used to treat stage III, stage IV, and
recurrent endometrial cancer.
 Signal transduction inhibitors block signals that are passed from
one molecule to another inside a cell. Blocking these signals may kill cancer
cells. Metformin is being studied to treat stage III, stage IV, and recurrent
endometrial cancer.