This document discusses endometrial cancer, including risk factors, types, clinical features, and histology. It notes that endometrial cancer risk is highest in developed countries and associated with factors like obesity, diabetes, and hormone therapy. There are two main types - Type 1 occurs in younger women, is estrogen-dependent and differentiated, while Type 2 occurs later, is estrogen-independent and undifferentiated. Clinical features include abnormal bleeding, while histology shows grades ranging from well to poorly differentiated adenocarcinoma.

1. SHRUTHI.S.JAYARAJ,53 RD
CALICUT MEDICAL COLLEGE

2. DEVELOPED COUNTRIES
DEVELOPING COUNTRIES
CA ENDOMETRIUM
CA CERVIX
 POOR HYGEINE
MULTIPARITY
EARLY MARRIAGE

3. 
INCIDENCE IS HIGHEST IN U.S, LOWEST IN
INDIA, JAPAN

PRIMARILY IN POST MENOPAUSAL LADIES
MEAN AGE ~ 60 yrs

4. OESTROGEN
RISK
FACTORS
OTHERS
OBESITY
DIABETES
HYPERTENSION
HNPCC

5. 
EXOGENOUS
HORMONE
REPLACEMENT
THERAPY
 TAMOXIFEN
FOR BREAST
CANCER
ENDOGENOUS
EARLY MENARCHE
LATE MENOPAUSE
PCOS
OBESITY
FUNCTIONING
OVARIAN TUMORS

6.  HORMONE THERAPY FOR POST MENOPAUSAL
LADIES :
‘FEMININE FOREVER’ !!!
OESTROGEN USED ALONE
OESTROGEN + PROGESTINS
RISK
RISK

7. 
SERM
 POTENT ANTAGONIST IN BREAST – Rx of CA
BREAST
PARTIAL AGONIST IN UTERUS
LONG TERM USE- ENDOMETRIAL
PROLIFERATION,CARCINOMA

8.  COMBINED ORAL HORMONAL PILLS HAVE A
PROTECTIVE EFFECT AND REDUSES RISK BY 4050%

9.  OBESITY REDUCES LEVEL OF
SERUM HORMONE BINDING
PROTEIN
FREE ESTROGEN
CIRCULATES IN BODY
 PERIPHERAL FAT : CONVERSION
OF EPIANDROSTENEDIONE TO
OESTRONE

10.  NULLIPAROUS WOMEN & WOMEN WITH PCOD
NON OVULATION
HIGH OESTROGEN
ENDOMETRIAL HYPERPLASIA ENDOMETRIAL
CANCER

11. NULLIPARITY
PCOS
EARLY MENARCHE
LATE MENOPAUSE
TAMOXIFEN
HRT
RISK
FACTORS
OBESITY
DIABETES
HYPERTENSION
LYNCH 2
/ HNPCC

12.  WOMEN WITH FAMILIAL LYNCH 2 SYNDROME
(HNPCC) ARE LIKELY TO SUFFER FROM
ENDOMETRIAL CANCER.

13.  TYPE 1
 TYPE 2

14. TYPE 1
 WELL
DIFFERENCIATED
 GLANDS BACK TO
BACK
 MINIMUM STROMA

15. TYPE 2
 POORLY
DIFFERENCIATED
 PREDOMINANTLY
SOLID PATTERN
 MINIMAL GLAND
FORMATION

16. 55-65 YRS
OESTROGEN DEPENDANT
PREVIOUS H/O EXPOSURE TO UNOPPOSED
OESTROGEN.
a/w OBESITY/HYPERTENSION/DIABETES
‘WELL DIFFERENCIATED’ & MIMICS
PROLIFERATIVE ENDOMETRIAL GLANDS.AS
SUCH,REFERRED TO AS ENDOMETRIOD
CARCINOMA
EXCELLENT PROGNOSIS

17. 65 – 75 yrs
OESTROGEN INDEPENDENT
UNRELATED TO HORMONE EXPOSURE
USUALLY ARISES IN AN ATROPHIC
ENDOMETRIUM
USUALLY UNDIFFERENCIATED & AGGRESSIVE
DEEP MUSCLE INVASION
BAD PROGNOSIS

18. TYPE 1
TYPE 2
 55-65 YRS
 65 – 75 YRS
 ESTROGEN
 ESTROGEN
DEPENDENT
 ENDOMETRIAL
HYPERPLASIA MAY BE
PRESENT
 WELL
DIFFERENCIATED
INDEPENDENT
 USUALLY IN ATROPHIC
ENDOMETRIUM
 UNDIFFERENCIATED

19. TYPE 1
TYPE 2
 STABLE
 AGGRESSIVE
 MINIMAL MUSCLE
 DEEP MUSCLE
INVASION
 HISTOLOGY –
ENDOMETRIOD
 EXCELLENT
PROGNOSIS
INVASION
 HISTOLOGY- SEROUS /
CLEAR CELL
 BAD PROGNOSIS

20.  ENDOMETRIAL CANCER MAY BE : LOCALISED/
DIFFUSE
APPEAR AS :
NODULE
POLYP
DIFFUSE LESION INVOLVING WHOLE
UTERINE CAVITY

21. DIFFUSE

22.  TO THE NAKED EYE THE ENDOMETRIAL
CURETTINGS APPEAR PALE & FRIABLE

HISTOLOGICALLY
75 % ADENOCARCINOMA
REST- SQUAMOUS / SEROUS

23. GRADE 1 : WELL DIFFERENCIATED ADENO CARCINOMA
< 5 % SOLID GROWTH PATTERN
GRADE 2
:
MODERATELY DIFFERENCIATED
ADENOCARCINOMA
6 – 50 % SOLID GROWTH PATTERN
GRADE 3
:
POORLY DIFFERENCIATED ADENOCARCINOMA
> 50 % SOLID GROWTH PATTERN

24. GRADE 1
GRADE 2
GRADE 3

25.  ENDOMETRIOD
 MUCINOUS
 PAPILLARY SEROUS
 CLEAR CELL
 SQUAMOUS
 UNDIFFERENCIATED
 MIXED

26.  ENDOMETRIOD
GOOD PROGNOSIS
 MUCINOUS
 PAPILLARY SEROUS
 CLEAR CELL
 SQUAMOUS
BADPROGNOSIS

27.  COMMONEST TYPE ~ 80 %
 COMPOSED OF GLANDS WHICH RESEMBLE
NORMAL ENDOMETRIAL GLANDS
 WELL DIFFERENCIATED & GOOD PROGNOSIS

28.  5 % OF CANCERS
 HAVE A MUCINOUS PATTERN
 WELL DIFFERENCIATED GLANDULAR PATTERN
 GOOD PROGNOSIS

29.  5 % ALL TUMORS
 EXHIBIT PAPILLARY PATTERN
 BEHAVE AGGRESSIVELY
 POOR PROGNOSIS
 HIGH RISK FOR LYMPHOVASCULAR SPACE
INVOLVEMENT AND DEEP MYOMETRIAL
INVASION EVEN WITH EARLY STAGE DISEASE
 SPREAD EARLY TO ABDOMEN

30.  5 % OF ALL CANCERS
 CELLS LARGE WITH ATYPICAL NUCLEI,CLEAR
CYTOPLASM, CONTAIN GLYCOGEN
 MAY SHOW HOBNAIL CONFIGURATION AND
FORM PAPILLARY STRUCTURES
 HIGHLY AGGRESSIVE
 BAD PROGNOSIS

31. A
B
c

32.  VERY RARE VARIETY
 R/O SPREAD FROM CERVICAL SQUAMOUS
EPITHELIUM
 VERY POOR PROGNOSIS EVEN WITH STAGE 1
DISEASE

33. CLINICAL FEATURES

34.  ASYMPTOMATIC IN 7- 10 %
 MANIFEST AS
MENORRHAGIA & IRREGULAR PERIODS
PERIMENOPAUSAL LADIES
POST MENOPAUSAL BLEEDING IN MENOPAUSAL
WOMAN

35. ELDERLY WITH CERVICAL STENOSIS
HAEMATOMETRA/PYOMETRA
PURULENT VAGINAL DISCHARGE

36.  SOME WOMEN EXPERIENCE PELVIC PRESSURE
AND PAIN DUE TO UTERUS ENLARGEMENT OR
EXTRAUTERINE SPREAD

37.  ADVANCED STAGE-
BULKY CERVIX,
GROWTH
PROTRUDING
THROUGH OS

38. THANK YOU