Endometrial hyperplasia

1. ENDOMETRIAL CANCER -I
DR P.PALLAVEE
2/15/2016

2. OBJECTIVES
• To be able to identify the risk factors
associated with endometrial cancer.
• To understand the pathology of the
premalignant stage.
• To be able to manage the premalignant
stage of endometrial cancer.
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3. CONTENTS
• Risk factors of endometrial cancer
• Definition of endometrial hyperplasia
• Types and malignant potential of
endometrial hyperplasia.
• Management of endometrial hyperplasia.
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4. FACTS:
• Endometrial cancer is commonest uterine
malignancy.
• Commonest gynecological cancer in
developed countries.[20-25%]
• In India Cervical cancer commonest.
• Median age at presentation is 61 yrs.
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5. RISK FACTORS
ENDOGENOUS ESTROGEN EXOGENOUS ESTROGEN
NULLIPARITY HRT
INFERTILITY/PCOS USE OF TAMOXIFEN
EARLY MENARCHE/LATE MENOPAUSE
OBESITY
FUNCTIONING OVARIAN TUMORS
OTHERS- DIABETES, HYPERTENSION, HYPOTHYROIDISM
HEREDITARY NON-POLYPOSIS COLORECTALCANCER SYNDROME
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6. PREVENTION
• ORAL CONTRACEPTIVE PILLS
[ decreases risk by 50 % if taken for 10 yrs
and effect lasts for 20 yrs]
• USE OF PROGESTOGEN
[ regular withdrawal in PCOS patients]
• LIFESTYLE MODIFICATION
• [ diet and exercise]
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7. ENDOMETRIAL HYPERPLASIA
• Defined as a proliferation of endometrial
glands of irregular size and shape with an
increase in the gland stroma ratio.
• Prolonged and unopposed estrogenic
stimulation in the absence of progesterone.
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8. TYPES OF ENDOMETRIAL HYPERPLASIA
• Classified according to complexity and
crowding of glandular framework
• Simple hyperplasia
• Complex hyperplasia
• Atypical hyperplasia-
Simple
Complex
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9. NORMAL ENDOMETRIUM SIMPLE HYPERPLASIA COMPLEX HYPERPLASIA
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10. ATYPICAL HYPERPLASIA
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11. MALIGNANT POTENTIAL
• Simple Hyperplasia without atypia- 1%
• Complex Hyperplasia without atypia- 3%
• Simple Hyperplasia with atypia- 8%
• Complex Hyperplasia without atypia- 29%
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12. Diagnosis
• ULTRASONOGRAPHY
• SALINE INFUSION SONOGRAPHY
• HYSTEROSCOPY & TARGETED BIOPSY
• ENDOMETRIAL BIOPSY-[ PIPELLE]
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13. TVS SIS
HYSTEROSCOPEPIPELLE2/15/2016

14. MANAGEMENT
1. Depends on patients age, reproductive
status,surgical risk and presence of cytological
atypia.
2. Hyperplasia without atypia-
• Progestogen- oral MPA, LNG-IUD
• Continuous for 3-6 mnths and reassess.
3. Atypical hyperplasia
• Hysterectomy
• Fertility sparing- High dose Progesterone
[ 6-43% cases of atypical hyperplasia may be
associated with endometrial carcinoma]
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15. Expected questions
• List the risk factors of endometrial
carcinoma.
• Enumerate the types of endometrial
hyperplasia.
• Diagnosis and management of
endometrial hyperplasia [ viva]
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16. References
• Textbook of Gynecology –Sheila
Balakrishnan
• Essentials of Gynecology- S.Arulkumaran
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17. THANK YOU
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