SHRUTHI.S.JAYARAJ,53RD

CALICUT MEDICAL COLLEGE

ENDOMETRIAL CARCINOMA

DEVELOPED COUNTRIES CA

ENDOMETRIUM DEVELOPING COUNTRIES CA CERVIX

MOST COMMON CANCER OF GENITAL TRACT

POOR HYGEINE

MULTIPARITYEARLY

MARRIAGE

INCIDENCE IS HIGHEST IN U.S, LOWEST IN INDIA, JAPAN

PRIMARILY IN POST MENOPAUSAL LADIES

MEAN AGE ~ 60 yrs

RISK FACTOR

S

OESTROGEN

OTHERSOBESITY

DIABETESHYPERTENSION

HNPCC

OESTROGEN EXPOSURE

EXOGENOUS

HORMONE REPLACEMENT THERAPY

TAMOXIFEN FOR BREAST CANCER

ENDOGENOUSEARLY MENARCHELATE MENOPAUSEPCOSOBESITYFUNCTIONING OVARIAN TUMORS

HORMONE THERAPY FOR POST MENOPAUSAL LADIES :

‘FEMININE FOREVER’ !!!

OESTROGEN USED ALONE RISK

OESTROGEN + PROGESTINS RISK

SERM POTENT ANTAGONIST IN BREAST – Rx

of CA BREAST PARTIAL AGONIST IN UTERUS

LONG TERM USE- ENDOMETRIAL PROLIFERATION,CARCINOMA

TAMOXIFEN

COMBINED ORAL HORMONAL PILLS HAVE A PROTECTIVE EFFECT AND REDUSES RISK BY 40-50%

OBESITY REDUCES LEVEL OF SERUM HORMONE BINDING PROTEIN FREE ESTROGEN CIRCULATES IN BODY

PERIPHERAL FAT : CONVERSION OF EPIANDROSTENEDIONE TO OESTRONE

OBESITY

NULLIPAROUS WOMEN & WOMEN WITH PCOD

NON OVULATION HIGH OESTROGEN

ENDOMETRIAL HYPERPLASIA ENDOMETRIAL CANCER

RISK FACTOR

S

NULLIPARITYPCOSEARLY

MENARCHELATE

MENOPAUSE

OBESITYDIABETESHYPERTE

NSION

LYNCH 2 /

HNPCC

TAMOXIFEN

HRT

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

FAMILIAL PREDISPOSITION

TYPE 1

TYPE 2

TYPES

TYPE 1WELL

DIFFERENCIATEDGLANDS BACK TO

BACKMINIMUM STROMA

TYPE 2POORLY

DIFFERENCIATEDPREDOMINANTLY

SOLID PATTERNMINIMAL GLAND

FORMATION

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 CARCINOMAEXCELLENT PROGNOSIS

TYPE 1 ENDOMETRIAL CARCINOMA

65 – 75 yrs OESTROGEN INDEPENDENT UNRELATED TO HORMONE EXPOSURE USUALLY ARISES IN AN ATROPHIC ENDOMETRIUMUSUALLY UNDIFFERENCIATED & AGGRESSIVEDEEP MUSCLE INVASION BAD PROGNOSIS

TYPE 2 ENDOMETRIAL CARCINOMA

TYPE 155-65 YRSESTROGEN

DEPENDENTENDOMETRIAL

HYPERPLASIA MAY BE PRESENT

WELL DIFFERENCIATED

65 – 75 YRSESTROGEN

INDEPENDENTUSUALLY IN

ATROPHIC ENDOMETRIUM

UNDIFFERENCIATED

TYPE 2

TYPE 1STABLEMINIMAL MUSCLE

INVASIONHISTOLOGY –

ENDOMETRIODEXCELLENT

PROGNOSIS

AGGRESSIVEDEEP MUSCLE

INVASIONHISTOLOGY-

SEROUS / CLEAR CELL

BAD PROGNOSIS

TYPE 2

ENDOMETRIAL CANCER MAY BE : LOCALISED/ DIFFUSE

APPEAR AS : NODULE POLYP DIFFUSE LESION INVOLVING WHOLE UTERINE CAVITY

MORPHOLOGY

LOCALISED

DIFFUSE

TO THE NAKED EYE THE ENDOMETRIAL CURETTINGS APPEAR PALE & FRIABLE

HISTOLOGICALLY 75 % ADENOCARCINOMA REST- SQUAMOUS / SEROUS

PATHOLOGY

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

GRADING (FIGO)

GRADE 1 GRADE 2

GRADE 3

ENDOMETRIODMUCINOUSPAPILLARY SEROUSCLEAR CELLSQUAMOUSUNDIFFERENCIATED MIXED

PATHOLOGICAL CLASSIFICATION OF ENDOMETRIAL CARCINOMA

ENDOMETRIOD GOOD PROGNOSIS

MUCINOUS PAPILLARY SEROUSCLEAR CELL

BADPROGNOSIS

SQUAMOUS

COMMONEST TYPE ~ 80 %COMPOSED OF GLANDS WHICH

RESEMBLE NORMAL ENDOMETRIAL GLANDS

WELL DIFFERENCIATED & GOOD PROGNOSIS

ENDOMETRIOD

5 % OF CANCERSHAVE A MUCINOUS PATTERNWELL DIFFERENCIATED GLANDULAR

PATTERN GOOD PROGNOSIS

MUCINOUS

5 % ALL TUMORSEXHIBIT PAPILLARY PATTERNBEHAVE AGGRESSIVELY POOR PROGNOSISHIGH RISK FOR LYMPHOVASCULAR SPACE

INVOLVEMENT AND DEEP MYOMETRIAL INVASION EVEN WITH EARLY STAGE DISEASE

SPREAD EARLY TO ABDOMEN

PAPILLARY SEROUS

5 % OF ALL CANCERSCELLS LARGE WITH ATYPICAL

NUCLEI,CLEAR CYTOPLASM, CONTAIN GLYCOGEN

MAY SHOW HOBNAIL CONFIGURATION AND FORM PAPILLARY STRUCTURES

HIGHLY AGGRESSIVEBAD PROGNOSIS

CLEAR CELL CARCINOMA

c

A B

VERY RARE VARIETYR/O SPREAD FROM CERVICAL SQUAMOUS

EPITHELIUMVERY POOR PROGNOSIS EVEN WITH

STAGE 1 DISEASE

SQUAMOUS

CLINICAL FEATURES

ASYMPTOMATIC IN 7- 10 %MANIFEST AS MENORRHAGIA & IRREGULAR PERIODS

PERIMENOPAUSAL LADIES POST MENOPAUSAL BLEEDING IN

MENOPAUSAL WOMAN

ELDERLY WITH CERVICAL STENOSIS

HAEMATOMETRA/PYOMETRA

PURULENT VAGINAL DISCHARGE

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

ADVANCED STAGE- BULKY CERVIX,

GROWTH PROTRUDING THROUGH OS

THANK YOU