In western countries endometrial cancer is common genital tract cancer. It has strong genetic origin like breast cancer.

1. Dr. Chaduvula Suresh Babu
Professor
Dept. of OBGYN
GIMSR
Visakhapatnam, AP, India

2. Third most common genital tract malignancy
ranks following Cancer cervix and ovary.
 Most common genital malignancy in western
world or industrialized world.
 Carcinoma endometrium or Cancer body of
the uterus are one and the same.

4.  In India the prevalence is 1.8 in 100,000.
 Age – Between 55- 69 years and average – 61.
 Occurrence – Mostly postmenopausal
 White population are at more risk
 India and Japan has lowest incidence.

5. 1. Obesity, Hypertension and Diabetes Mellitus
[Corpus cancer syndrome]
2. Nulliparity / Oligoparity
3. History of Cancers in the family – Breast,
Ovary
4. Late menopause
5. High socioeconomic status
6. Unopposed estrogen stimulation
7. Long term use of Tamoxifen
8. Genetics – Lynch II & Cowden

8.  1. Regular ovulation
 2. COC pills
 3. Multiparity
 4. Smoking
 5. Low Fat diet
 6. Physical exercise

9.  Type 1 – Estrogen dependent, Pre &
Perimenopausal women, well differentiated,
good prognosis.
 Type II – Estrogen independent, post-
menopausal women, thin and fertile women,
aggressive, poor prognosis, more common in
Asian or African–American descent

10.  Stage 1 – Cancer confined to uterus
 Stage 1 A – either limited to endometrium or
< 50 % of myometrium, LN [ 2%]
 Stage 1 B - > 50 % of myometrium, LN [ 10-
40%]

11.  II stage – extended to cervical stroma
 [glandular involvement is still cancer stage 1]

12.  Cancer extends outside the uterus but is
confined to true pelvis.
 III A – Serosa / or adnexa
 III B – Vaginal Metastasis
 III C – Pelvic / or Para-aortic lymph nodes
 III C 1 – Pelvic Lymph nodes
 III C 2 – Para-aortic LN + with or without
Pelvic LN

13.  Metastasis to Bladder, rectum and distant
sites.
 IV A – Bladder and Rectal mucosa
 IV B – Distant metastasis – lungs, liver, brain
and bones and Inguinal Lymph nodes +

14.  1. Fundus – Para-aortic
 2. Cornu – Superficial Inguinal
 3. Body – External Iliac
 4. Isthmus and cervix –Pre-sacral, Para-
cervical, internal iliac and external iliac
 5. Vaginal – Deep inguinal

15.  1. Direct
 2. Lymphatic
 3. Haematogenous
 4. Transtubal

16.  1. Adenocarcinoma
 2. Clear cell carcinoma
 3. Papillary Serous
 4. Adeno-squamous
 5. Squamous cell type
 6. Secretory adenocarcinoma

19.  Grade I – 5% or less of non-squamous or non-
morular solid growth pattern
 Grade II – 6-50% of non-squamous or non-
morular solid growth pattern
 Grade III – More than 50% of non-squamous or
non-morular solid growth pattern

20.  Post menopausal bleeding / Abnormal uterine
bleeding
 Purulent and offensive vaginal discharge
 Hydrorrhea – Mucoid discharge
 Lower abdominal pain – Simpson’s Pain
 Passage of polypoidal growths
 Lump abdomen
 Loss of appetite and weight

21.  Cachexia
 Asymptomatic
 Bladder and rectal pressure symptoms
 Lung and Liver metastasis
 Bony pains

22.  Per Speculum – para-urethra and vaginal
nodules with atrophic vagina
 Per vaginal – Atrophic, Normal or enlarged
uterus, regular/ irregular, mobile or fixed
 P/V/R – to know the rectovaginal septum and
parametrial involvement.

23.  Clarke’s Sign – Bleeding while passing uterine
sound

24.  1. Endometrial aspiration cytology – Pippele’s
canula or Vibra aspirator
 2. Fractional Curettage
 3. Pap Smear
 4. Hysteroscopy
 5. Ultrasound
 6. CT/MRI
 7. PET Scan

25.  Fractional curettage – Gold standard test
where 2 samples were taken, one from endo-
cervical curettage and entire endometrial
curettage
 Trans-vaginal ultrasound – Endometrial
thickness >4 mm in post menopausal women
will require a diagnostic curettage
 CT/MRI/PET Scan – advanced diseases

27.  Surgery is the main treatment -
 Extra facial Hysterectomy
 Bilateral salpingo-oopherectomy
 Removal of cuff of vagina and
 Peritoneal washings for Cytology
 +/- Lymphadenectomy

28.  Experienced Pathologist along with Frozen
section facilities are essential for the
completion of surgery
 Gynaecologist / Gynae-oncologist
 Peritoneal washings – no role
 Selective Lymphadenectomy - Controversial

29.  1. Grade II & III Cancers
 2. Papillary, Serous and Carcinosarcoma types
 3. Grossly positive pelvic lymphnodes
 4. Grossly positive adnexa
 5. Invasion of > half of myometrium
 6. Suspicious common Iliac and Para-aortic
LN

31.  Cervix must be closed
 Fimbrial ends should be closed
 Do not hold uterus with volsellum

32.  Vaginal Hysterectomy with BSO followed by
radiotherapy. With prolapsed patients
 Fertility sparing treatment – Premenopausal
with stage IA non myo-invasive – TAH without
oopherectomy.

33.  Primary – Advanced cancers, unresectable
masses – Intra-cavitary RT and External Beam
RT with Cobalt with Linear accelerator.
 Secondary – Following Surgery

34.  Chemotherapy along with Radiotherapy is the
option for advanced and disseminated
disease.
 Cisplatinum, Doxorubicin, Paclitaxel etc

35.  Positive PG receptor and positivetive
estrogen receptor patients
 Medroxy Progesterone acetate
 17 hydroxy progesterone caproate
 Mirena
 Indications:
 Well differentiated type

36.  Low risk – Stage I A , Grade I & II – do not
require postop Radiotherapy and follow-up
 High Risk – Stage I B, Grade III, Papillary,
Clear cell types, Lympho-vascular space
invasion – Requires Radiotherapy
 Treatment –
 Radiation therapy + Chemotherapy.
 Hormonal therapy

37. Stage I 81-91%
Stage II 67-77%
Stage III 33-60%
Stage IV 5-20%

38. Thank You All