ENDOMETRIAL

CARCINOMA

DR. OKAGUA
ENDOMETRIAL CARCINOMA
INTRODUCTION
EPIDERMIOLOGY
AETIOLOGY
PATHOLOGY
MODE OF SPREAD
STAGING
CLINICAL PRESENTATION
DIAGNOSIS
TREATMENT
PROGNOSIS
 INTRODUCTION

Most common malignancy of the corpus uteri

Arises from the lining of the uterus
Generally believed to carry good prognosis
 EPIDERMIOLOGY
AGE – majority > 45yrs
median = 61yrs
INCIDENCE – varies
- highest in white North
Americans
 AETIOLOGY
Endometrial hyperplasia
Risk factors
INCREASED RISK FACTORS
Obesity especially upper body
Impaired carbohydrate tolerance
Nulliparity
Late menopause
Polycystic ovarian syndrome
Unopposed oestrogen therapy
Functioning ovarian tumours
 RISK FACTORS (cont.)
Personal history of breast or colon cancer
Family history of breast, colon, ovarian or
endometrial cancer (Lynch II syndrome)
Tamoxifen therapy
Previous pelvic irradiation
DECREASED RISK
Oral contraceptives
Progestogens
Cigarette smoking
 PATHOLOGY
MACROSCOPY – raised, rough area
often in the fundus of the uterus
HISTOLOGICAL SUBTYPES
1. Endometriod adenocarcinoma
2. Adenoacanthoma
3. Adenosquamous carcinoma
4. Papillary serous & clear cell carcinomas
 MODE OF SPREAD
DIRECT SPREAD – myometrium, cervix
(+ parametrium), fallopian tubes, ovaries
LYMPHATIC SPREAD – pelvic, paraaortic
VASCULAR SPREAD
TRANSPERITONEAL SPREAD – via
serosal surface or fallopian tubes to
peritoneal surfaces and omentum
 STAGING (FIGO)
Stage I Carcinoma confined to corpus
Ia Tumour limited to endometrium
Ib Invasion < half of myometrium
Ic Invasion > half of myometrium
Stage II Invasion of corpus & cervix but not outside the uterus
IIa Endocervical glandular involvement only
IIb Cervical stromal invasion
Stage III Extension outside uterus but not outside true pelvis
IIIa Invasion of serosa/ adnexae/ +ve peritoneal
cytology
IIIb Vaginal metastasis
IIIc Metastasis to pelvic and/or para-aortic nodes
Stage IV Distant metastasis (excluding bullous oedema)
IVa Invasion of bladder and/or bowel mucosa
IVb Distant metastasis (+inguinal, intra-abdominal
nodes)
 CLINICAL PRESENTATION
HISTORY
Postmenopausal bleeding (75-80%)
Postmenopausal vaginal discharge
Pelvic pain
Irregular vaginal bleeding/ menorrhagia
PHYSICAL EXAMINATION
Enlarged groin/supraclavicular nodes
Vaginal lesion (metastatic focus)
Enlarged uterus
Palpable focus in adnexae/parametrium
Breast examination (possible site of primary tumour)
 INVESTIGATIONS
SCREENING
Endometrial sampling – endometrial biopsy
(Sharman curette, pipelle, z-sampler), aspiration
curettage, endometrial lavage, endometrial
brush sponge, endometrial aspiration
Vaginal or Cervical cytology
Vaginal ultrasound scan
DIAGNOSIS
EUA + Hysteroscopy + D&C under GA
ASSESSMENT OF METASTASIS
Chest X-ray, IVU, ultrasound, MRI
FBC, E/U/Cr, Urinalysis
 TREATMENT
Stage 1
TAH + BSO (+ Radiotherapy for stage Ic)
Stage II
- Radical hysterectomy + bilateral pelvic lympha-
adenectomy + para-aortic node sampling
- Radiotherapy for unfit patients
Stage III
Surgery + adjuvant radiotherapy
Stage IV
- Individualized
- Usually radiotherapy +/- surgery for residual dx.
Recurrent disease
- Radiotherapy, progestogens (Rx & Pv), cytotoxics
 PROGNOSIS
PROGNOSTIC FACTORS
Stage of disease
Grade of disease
Myometrial invasion
Tumour size
Age

General belief that it carries a good prognosis

is being disputed. 5yr survival approaches
that of Carcinoma of the Cervix