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1、Uterine Cancer,General Description,Uterine cancer is one of the most common malignancy of female genital tract. The incidence is increasing worldwide in recent years. Overall,2%-3% of women develop uterine cancer during their lifetime.,General Description,A malignant epithelial disease that occurs i
2、n endometrial gland of uterus Also called endometrial cancer,Classification (pathogenetic,biologic behavior ),Estrogen dependent type have a history of exposure to unopposed estrogen (either endogenous or exogenous). Hyperplastic endometrium Better differentiafed ER(+),PR(+) Mere favorable prognesis
3、,Estrogen independent type,- Have no source of estrogen stimulation of endometrium. -Arising in background of atrophic endemetrium -Less differentiated -ER(-)PR(-) -Poor prognosis,Risk Factors,1. Medical conditions a. Diabetes mellitus, hypertension. b. Overweight-obesity (excess estrogen as a resul
4、t of peripheral conversion of adrenally derived androstenedione by aromatization in fat). c. Late menopause.,Risk Factors,2. Some gynecologic diseases ( Long-term endogenous estrogen exposure ) - polycystic ovary syndrome - functioning ovarian tumors - anovulating dysfunctional bleeding - Infertilit
5、y, Nulliparity.,Risk Factors,3. Prolonged Use of estrogen a. Prolonged menopausal estrogen replacement therapy without progestogen. b. Prolonged use of the antiestrogen tamoxifen for breast cancer.,Risk Factors,4. Genetic factors and other factors a. Endometrial and ovarian cancer are the simultaneo
6、usly occurring with other genital malignancy ,reported incidence (1.43.8%). b. Family history of tumor is higher.(12-28%),Five histological subtypes,Endometrioid adenocarcinoma Mucinous carcinoma Serous adenocarcinoma Clear cell carcinoma Other rare subtypes,Five histological subtypes -Endometrioid
7、Adenocarcinoma,Account for about 8090%. Well differentiated. Prognosis is better.,Five histological subtypes -Mucinous carcinoma,Rare (about 5%) a. Most of them is a well differentiated. b. Behavior is similar to that of common endometrial carcinoma.,Five histological subtypes -Serous adenocarcinoma
8、,a. Architecture is identical with complex papillary. b. More aggressively with deep myometrial and lymphatic invasion. c. Simulating the behavior of ovarian carcinoma.,Five histological subtypes -Clear cell carcinoma,a. A rare subtype b. Is high grade and aggressive c. Prognosis is similar to or wo
9、rse than that of papillary serous carcinoma d. Survival rate is lower 33%64%,Five histological subtypes -other rare subtypes,Squamous adenocarcinoma Undifferentiated carcinoma Mixed adenocarcinoma,Clinical Features-Symptoms,Asymptomaic (about less than 5% ) Abnormal vaginal bleeding (premenopausal o
10、r postmenopausal, minimal or nonpersistant) Abnormal vaginal discharge(25% infection of uterine contents) Pelvic pressure or discomfort (uterine enlargement or extrauterine disease spread),Clinical Features-Signs,No evidence in early stage on physical examination Slight enlargement of uterine size a
11、nd soft Uterus fixed, immobile, adenexal mess in advanced stage,Special Examination,Dilation and fractional curettage ( D. C) Most effective ,definitive procedure and commonly used Significance -Established correct diagnosis, clinical stage -differentiated from cervical cancer or cervical involvemen
12、t,Ultrasonography Useful adjuvant method Significances Size of lesion Invasion of endometrium or cervix Resistant index of new vessels,Endometrial carcinoma in a 58-year-old woman with substantial postmenopausal bleeding. (A) Sagittal transvaginal US scan shows the endometrium with a thickness of 44
13、 mm and a large area of mixed echogenicity suggestive of a mass. (B) Transverse sonohysterogram shows a 50-mm-diameter polypoid mass protruding into the endometrial cavity (calipers indicate the stalk of the mass). Histopathologic findings indicated poorly differentiated endometrial carcinoma.,A,B,H
14、ysteroscopy Significance -Direct observation -Taking sample correctly -Identifying polyps and submucous myoma,Pap test -Unreliable diagnostic test -30%-50% abnormal pap test results Others -MRI, CT, chest x-ray, IV urography, cystoscopy, sigmoidoscopy,Diagnosis,History, and clinical sign , related r
15、isk factors symptoms Diagnostic methods,Differential Diagnosis,Senile endometritis / vaginitis Dysfunctional uterine bleeding Submucous myoma / Endometrial polyps Cervix cancer / Sarcoma of uterus/ Primary carcinoma of fallopian tube,Metastasis Route,Direct extension Lymphatic metastasis: important
16、route Hematogenous metastasis,Clinical Stage (FIGO 1971),Stage I Ia The carcinoma is confined to the corpus and the length of the uterine cavity is 8 cm Ib The carcinoma is confined to the corpus and the length of the uterine cavity is 8 cm Stage II The carcinoma has involved the corpus and the cervix, but has not extended outside the uterus,Clinical Stage (FIGO 1971),Stage III The carcinoma has extended outside the uterus, but not outside the true pelvis Stage
