Carcinoma of the endometrium
Download
1 / 46

CARCINOMA OF THE ENDOMETRIUM - PowerPoint PPT Presentation


  • 186 Views
  • Uploaded on

CARCINOMA OF THE ENDOMETRIUM. Wen Di , M.D. , Ph.D. One of the commonest gynecological cancers , especially in white Americans , it occurs most often in postmenopausal women ( up to 80 % of cases ) with less than 5 % diagnosed under 40 years of age ..

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'CARCINOMA OF THE ENDOMETRIUM' - jacob


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Carcinoma of the endometrium

CARCINOMA OF THE ENDOMETRIUM

Wen Di , M.D.,Ph.D

Carcinoma of the Endometrium


Carcinoma of the Endometrium


  • There is no effective screening programme,but occasionally cervical smears contain endometrial cancer cells or double thickness endometrial ultrasonic thickness of 4mm or more indicates a need for endometrial sampling.

Carcinoma of the Endometrium


Risk factors
Risk Factors

  • The actual cause of this cancer is unknown.

  • Estrogen

  • given estrogen alone as postmenopausal hormone replacement therapy

  • Estrogen secreting tumors of the ovary are associated with an increased incidence of endometrial carcinoma.

Carcinoma of the Endometrium


  • There can be no doubt that oestrogen can alter the behaviour of this tumour but there is still a question about oestrogen as a primary causal agent.

  • Approximately 75%of cases of endometrial cancer occur in the postmenopausal period when estrogen values are low and progesterone is absent.Nulliparity and PCO syndrome(with defective progesterone synthesis)carry an increased risk.

Carcinoma of the Endometrium


  • Only a proportion of obese behaviour of this tumour but there is still a question about oestrogen as a primary causal agent,diabetic and hypertensive women develop endometrial cancer and similarly only a proportion of women with endometrial cancer are obese,diabetic or hypertensive.The question remains whether estrogen is a causal agent,or is acting in its normal capacity as a growth factor and is really to be regarded as a co-carcinogen.

Carcinoma of the Endometrium


Carcinoma of the Endometrium behaviour of this tumour but there is still a question about oestrogen as a primary causal agent


  • Oral contraception behaviour of this tumour but there is still a question about oestrogen as a primary causal agent,especially after long term use,reduces the incidence of both endometrial and ovarian carcinomas.

Carcinoma of the Endometrium


Carcinoma of the Endometrium


  • Symptomatology endometrial polyps

  • The usual presenting symptom of endometrial carcinoma is postmenopausal bleeding which carries a 10%risk of associated malignancy in the absence of hormone replacement therapy. Curettage,or endometrial sampling is mandatory. Postmenopausal discharge from pyometra carries a 50% risk of associated malignancy. Pain may occur with pyometra or metastatic spread.

Carcinoma of the Endometrium


  • Diagnosis endometrial polyps

  • Hysteroscopy with endometrial curettage or endometrial sampling,curettage alone,or outpatient endometrial sampling alone,are essential.Curettage is not infallible.On the other hand,if a Pipelle has been correctly introduced(record how many cm)and the pathology is benign, or no tissue is obtained,it is most unlikely that malignancy exists.

Carcinoma of the Endometrium


  • Hysteroscopy endometrial polyps,cervical smear(>1%risk of concurrent cervical malignancy)and vaginal or abdominal ultrasound for ovarian pathology are advised,when endometrial malignancy is found.

Carcinoma of the Endometrium


Carcinoma of the Endometrium endometrial polyps


Carcinoma of the Endometrium endometrial polyps


Carcinoma of the Endometrium endometrial polyps


  • Further groups have been described. endometrial polyps

  • Adeno-squamoid group

  • This has been divided into two groups:

  • 1. If the squamous cells are well differentiated the tumour is termed adeno-acanthoma (Histological Grade 1)

  • 2.Poorly differentiated squamous cells merit the name adeno-squamous carcinoma (Grade 2).

Carcinoma of the Endometrium


Carcinoma of the Endometrium endometrial polyps


Carcinoma of the Endometrium endometrial polyps


Staging endometrial polyps

Carcinoma of the Endometrium


Carcinoma of the Endometrium endometrial polyps


Carcinoma of the Endometrium endometrial polyps


Carcinoma of the Endometrium


  • Local Spread cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.

  • Slow invasion of the myometrium is the commonest spread. It may produce considerable uterine enlargement; or spread may involve the vaginal vault.

Carcinoma of the Endometrium


  • Venous Spread cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.

  • This pathway might account for the occasional appearance of a low vaginal metastasis; but venous spread is not a common feature of uterine cancer.

Carcinoma of the Endometrium


  • Lymphatic Spread cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.

  • The incidence of this (it is much debated) seems to be somewhere between 10 and 30%. All pelvic nodes, including the internal iliacs, the parametrium, the ovaries, and the vagina may be involved, probably with equal frequency. Lymphatic spread is more likely to occur when the tumour is anaplastic and the uterine wall is deeply invaded.

Carcinoma of the Endometrium


  • Tubal Spread cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.

  • Malignant cells can pass along the tube in the same way that peritoneal spill may occur during menstruation. This may account for isolated ovarian metastases.

Carcinoma of the Endometrium


Carcinoma of the Endometrium cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.


Carcinoma of the Endometrium cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.


Prognosis of endometrial carcinoma
PROGNOSIS OF ENDOMETRIAL CARCINOMA cavity, probably because the endometrium lacks lymphatics. A chest X-ray helps detect lung metastases. Magnetic resonance imaging is preferable to ultrasound for detection of myometrial invasion and pelvic spread.

  • With the exception of stage 1 tumors of histological grades I and II, the prognosis is less favourable than many gyaecologists believe,with an overall 5 year survival of 70% approximately.Fortunately over 80%of cases are dagnosed at stage 1.

Carcinoma of the Endometrium


Carcinoma of the Endometrium


Carcinoma of the Endometrium


Carcinoma of the Endometrium


Treatment of endometrial carcinoma
TREATMENT OF ENDOMETRIAL CARCINOMA survival rates for Stage I are the only ones altered significantly

  • This is essentialy surgical,with postoperative radiotherapy added when unfavourable prognostic features are found at surgery.Pre-operative clinical Staging is inaccurate.Progestogen therapy is probab1y only of value in recurrent disease.

Carcinoma of the Endometrium


  • Few women are unfit for surgery survival rates for Stage I are the only ones altered significantly,and caesium insertion radioactive therapy may be employed for these,but radiation alone is less effective than combined surgical and radiation treatment.

Carcinoma of the Endometrium


  • Stage I survival rates for Stage I are the only ones altered significantly

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy without partial removal of vagina. Peritoneal saline washings are taken for cytology on opening the abdomen and the Abdominal contents carefully examined.Vaginal hysterectomy with removal of ovaries, sometimes laparoscopy-assisted,has equal 5 year survival and lower operative mortality,in appropriate hands.

Carcinoma of the Endometrium


  • Stage II survival rates for Stage I are the only ones altered significantly

  • Stage IIa carries a similar prognosis to Stage I and may be treated as stage I.

  • Stage IIb,with clinical invasion of the cervix,has a poorer prognosis than Stage I and radical hysterectomy,pelvic lymphadenectomy and para-aortic lymph node sampling are indicated,with a combination of local and external radio therapy as an alternative treatment.

Carcinoma of the Endometrium


  • Stage III survival rates for Stage I are the only ones altered significantly

  • Following the Staging laparotomy,radical hysterectomy,lymphadenectomy,para-aortic node sampling and removal of as much malignant tissue as possible,omentectorny is carried out.Stage III diseases limited to the pelvis may be treated by radiotherapy.

Carcinoma of the Endometrium


  • Stage IV survival rates for Stage I are the only ones altered significantly

  • Treatment of this Stage is designed to control tumour growth and alleviate symptoms.Surgery,radiation therapy,cytotoxic therapy and adjuvant progestogen therapy all have a place.

Carcinoma of the Endometrium


Carcinoma of the Endometrium survival rates for Stage I are the only ones altered significantly


Carcinoma of the Endometrium


Recurrence of endometrial carcinoma
RECURRENCE OF ENDOMETRIAL CARCINOMA cervix

  • The incidence of recurrence within 5years is in the region of 30%and is accepted along with the 5-year survival rate as a measure of the effectiveness of the various systems of treatment.The majority recurrences appear within 3 years of treatment. Early recurrence has a poor Prognosis.

Carcinoma of the Endometrium


  • PROGESTOGENS cervix

  • Many endometrial carcinomata are hormone dependent and progestogens have been used as part of a combined primary treatment as well as for recurrent or metastatic growths.

Carcinoma of the Endometrium


  • Between 15 cervix%and 50%of recurrences will respond.Medroxyprogesterone acetate,400 mg to 600 mg daily,is most commonly employed and the addition of tamoxifen may improve the response.

Carcinoma of the Endometrium


  • Chemotherapy cervix

  • Cytotoxic chemotherapy has a limited place in advanced recurrence.Single agent therapy with adriamycin, cisplatinum ,cyclophosphamide and hexamethylmelamine gives response rates between 20%and 40%.

Carcinoma of the Endometrium



Carcinoma of the Endometrium


ad