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1、Endometrial Cancer OB GYN Hospital Fudan University Xin LU MD Ph D 1 Endometriod cancer Contents Incidence Risk factors Classification Symptoms Pathology FIGO Staging Diagnosis Treatment 2 WHO Cancer Report Global cancer rates could increase by 50 to 15 million by 2020 Endometrial cancer is the 4th
2、most common cancer in women New Diagnosed cases 142 000 Died cases each year 42 000 incidence 2 3 Average age 60s 3 Histologic Types Endometrial Cancers Endometrioid 87 Adenosquamous 4 Papillary Serous 3 Clear Cell 2 Mucinous 1 Other 3 4 Endometrial Cancer Type I II Type I Estrogen Related Younger a
3、nd heavier patients Low grade Background of Hyperplasia Perimenopausal Exogenous estrogen Familial genetic 15 Lynch II syndrome HNPCC Familial trend Type II 10 Aggressive High grade Unfavorable Histology Unrelated to estrogen stimulation Occurs in older 40 553 Patients with persistent PMB after nega
4、tive office biopsy should have D C hysteroscopy D C is the gold standard sampling method preoperative D C will agree with diagnosis at hysterectomy 94 of the time 26 27 28 29 Treatment for Endometrial Hyperplasia without atypia Progestin therapy continuous or cyclical Childbearing age Progestin domi
5、nant OCPs or Depo Provera 150mg IM q3 months or Provera 10mg po 10 days month and May follow with ovulation induction after normal biopsy if pregnancy desired Peri or Postmenopausal Provera 20mg po 10 days month or Depo Provera 200mg IM q2 months Repeat biopsy in 3 4 months 30 Treatment for Atypical
6、 Endometrial Hyperplasia 23 risk of progression to carcinoma over 10 years if untreated Standard treatment when childbearing is complete is total hysterectomy abdominal or vaginal Frozen section to rule out carcinoma up to 20 have coexisting endometrial cancer 31 Treatment for Atypical Endometrial H
7、yperplasia Conservative medical therapy can be attempted in younger patients who request preservation of fertility D C prior to initiation of medical therapy to rule out carcinoma Megace 40 80mg day Norethindrone acetate 5mg day Conservative therapy may also be attempted in young patients with early
8、 well differentiated endometrial carcinomas Megace 120 200mg day Norethindrone acetate 5 10mg day 32 Endometroid carcinoma Grading FIGO Gr 1 50 solid tumor NUCLEAR GRADE Size shape staining and chromatin variability prominent nucleoli High nuclear grade adds one point to FIGO grade 33 CA125 Chest X
9、ray Mammograms Colon Evaluation Others as indicated Uterine Cancer Pre op Evaluation 34 Uterine Cancer Pre op Evaluation Transvaginal U S CT Scan MRI 35 Uterine Cancer Pre op Evaluation 36 Uterine Cancer Surgical Staging Preoperative preparation Antimicrobial prophylaxis DVT prophylaxis Steep Trende
10、lenburg Long instruments available 37 Availability of frozen section to determine the extent of staging procedure Capability of complete surgical staging Capability of tumor reduction if indicated Endometrial Cancer Intra operative Surgical Principals 38 Endometrial Cancer Surgical Approach TAH BSO
11、washings only Endometrioid Grades 1 and 50 myometrial invasion or Grade 2 and no or minimal invasion and 50 myometrial invasion Any 2 cm tumor diameter All Serous clear cell subtype Pre operative assessment of advanced disease gross cervical or vaginal dz etc TAH BSO washings lymphadenectomy omental
12、 peritoneal biopsy 40 Endometrial Cancer Adjuvant Therapy Brachytherapy External beam radiotherapy Hormonal therapy Cytotoxic chemotherapy Combination therapy 41 Endometrial Cancer Recurrence Pelvic examination Pap smears CA125 high risk Chest X ray high risk 42 Endometrial Cancer Site of Recurrence In Radiated Patients Site Distant65 Pelvic and distant15 Pelvis only15 Vagina5 43 Endometrial Cancer Follow Up 75 95 of recurrences are in first 36 months 60 of patients have symptoms pain wgt loss vaginal bleeding Rare to cure distant recurrences 50 vaginal recurrences cured 44 45
