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1、Endometrial CarcinomaGeneral Considerations Endometrial carcinoma is one of the most Endometrial carcinoma is one of the most three common pelvic genital cancer in three common pelvic genital cancer in women.women.It is malignant epithelioid tumor. It is malignant epithelioid tumor. The incidence of
2、 endometrial cancer has The incidence of endometrial cancer has now raised. now raised. The peak incidence of onset is in the age The peak incidence of onset is in the age 58-61 years.58-61 years.Etiology Etiology of endometrial carcinoma may involve two mechanisms estrogen-dependent estrogen-indepe
3、ndentcertainPathologyEndometrioid adenocarcinomaSerous adenocarcinomaClear cell carcinomasMucus adenocarcinoma OthersMETASTASISDirect invasionLymphatic metastasis Vascular metastasis(advanced stage)SYMPTOMS mostly of the disease occurs in the elder patients,there is no symptoms at the very early sta
4、ge and it is only discovered by examine. abnormal vaginal bleeding vaginal fluiding. pelvic painweakness, weight loss, and anemia Physical examination is usually unremarkable at the very early stage. the uterus may be enlarged and the mass may move out of the cavity in the advanced cases.Some signs
5、of metastasis can be found of the late stages of the diseaseSIGNS Diagnosis HistoryHistory：clinical representation and high riskclinical representation and high risk factor, family history factor, family history vaginal bleedingvaginal bleeding High-risk factorsHigh-risk factors Long term use of E2,
6、TAMLong term use of E2,TAM Family history of breast cancer and endometrial Family history of breast cancer and endometrial carcinomascarcinomasSignsSigns Special ExaminationsFractional curettage Endometrial biopsyEndocervical curettageDiagnose of endometrial carcinoma needs the pathologic resultsEnd
7、ometrial cytology exam are also used in Endometrial cytology exam are also used in some patients. some patients. Ultrasonography can be helpful in deciding Ultrasonography can be helpful in deciding clinical staging, In postmenopausal women, clinical staging, In postmenopausal women, 4mm is the cut
8、off for a normal unilateral 4mm is the cut off for a normal unilateral endometrial stripe. endometrial stripe. The function of cavityscopy is controversy. The function of cavityscopy is controversy. MRI and CT appear to improve the accuracy MRI and CT appear to improve the accuracy of clinical stagi
9、ng and is particularly helpful in of clinical staging and is particularly helpful in identifying myometrial invasion. identifying myometrial invasion. Serum CA-125, a well-established tumor Serum CA-125, a well-established tumor marker can also be useful for endometrial marker can also be useful for
10、 endometrial cancer. cancer. Special ExaminationsDifferentiationDysfunctional uterine bleeding in the menopause women Senile vaginitisEndometrial polypusPelvic genital cancer in womenEndometritis in eldersCLINICAL STAGE According to anatomic sitesStage IStage I： endometriumendometriumStage IIStage I
11、I： cervix cervixStage IIIStage III: : parametrialparametrial，within within pelvispelvisStage IVStage IV：beyond metastasisbeyond metastasisClinical staging(FIGO1971)Clinical staging(FIGO1971) According to the Fractional curettage and clinical According to the Fractional curettage and clinical examina
12、tionexamination Pre-operation stagingPre-operation staging Used in the patients who treat Radiation as Used in the patients who treat Radiation as primary therapyprimary therapySurgical-pathological staging (FIGO1988)Surgical-pathological staging (FIGO1988) the last staging for the patients who choo
13、se the last staging for the patients who choose surgery as the principal therapysurgery as the principal therapy It is the last staging for the majorityIt is the last staging for the majorityStagingTHERAPY Treatment plan for endometrial carcinoma depends on its clinical staging and common conditionS
14、urgery , radiation therapy and drugs are all in usePrimary surgery with concomitant therapy is the main treatment in the early stage patients While in the late stages of the disease include radiation, surgery and drugs therapy. Surgical treatment :Surgical treatment :Primary treatment, especially in
15、 the early Primary treatment, especially in the early stagesstagesPurposePurpose Definitude the staging and prognostic factorsDefinitude the staging and prognostic factors Excise the lesionExcise the lesion THERAPYSURGICAL TREATMENT clinical stage simple hysterectomy and bilateral salpingo-oophorect
16、omy has been recommended Make sure to obtain peritoneal washings for cytologic identification of occult spread. The uterus should be opened in the operating room to determine the need for lymphadenectomy. The need for lymphadenectomySpecial pathological typeSpecial pathological typeGreater than 50%
17、myometrialGreater than 50% myometrial invasion invasion Low differentiationLow differentiation（G3G3） 50 50 cavity be involved by the lesioncavity be involved by the lesionCervical extension Cervical extension SURGICAL TREATMENT SURGICAL TREATMENT clinical stage II clinical stage II radical hysterect
18、omy and bilateral salpingo- radical hysterectomy and bilateral salpingo-oophorectomy has been recommendedoophorectomy has been recommended pelvic and para-aortic lymphadenectomy is pelvic and para-aortic lymphadenectomy is necessarynecessary Make sure to obtain peritoneal washings Make sure to obtai
19、n peritoneal washings open the uterus in the operation and expect open the uterus in the operation and expect the PR and ER receptors. the PR and ER receptors. SURGICAL TREATMENT clinical stage ， cytoreductive surgery should be attempted if possible Radiation therapy simply is used in patients with
20、operation forbiddance or in the late stages. Postoperative adjuvant radiation therapy is Postoperative adjuvant radiation therapy is indicated in patients withindicated in patients with extrauterineextrauterine extension extension lower uterine segment or cervical lower uterine segment or cervical i
21、nvolvement involvement myometrialmyometrial invasion 1/2 invasion 1/2 poor histologicpoor histologic differentiation differentiation papillary serous or clear cell histologypapillary serous or clear cell histology RADIATION THERAPY Adjuvant radiation therapy preoperatively is indicated in reducing t
22、umor size to create operation condition and eliminate the hiding metastasis lesion. Radiation therapy can be carried out inside or outside body.RADIATION THERAPY HORMONE THERAPY Progesterone has been the treatment of Progesterone has been the treatment of recurrent endometrial carcinoma not recurren
23、t endometrial carcinoma not amenable to irradiation or surgery. amenable to irradiation or surgery. Patients who are young also use Patients who are young also use progesterone therapy to keep fertility. The progesterone therapy to keep fertility. The drugs are manual composed with high drugs are ma
24、nual composed with high dose. curative effect should be estimated dose. curative effect should be estimated every 2-3months. every 2-3months. TamoxifenTamoxifen has been used as another has been used as another hormonal agent in advanced or recurrent hormonal agent in advanced or recurrent endometri
25、al cancer endometrial cancer ANTITUMOR CHEMOTHERAPY Chemotherapy of single drug or combined drugs is appropriate in the advanced or recurrent endometrial cancer. Follow-upTime Time ： 2-32-3rdrd year: once every 3 months year: once every 3 months 3-5 3-5thth year: once every 6 months year: once every 6 months 5 5thth year: once every year year: once every yearContent Content ： pelvic examinationpelvic examination cytological exam of the residual cytological exam of the residual vaginavagina chest X-Ray, CA125 chest X-Ray, CA125
