Download 子宫内膜癌

Endometrial Carcinoma
Women’s Hospital, School of Medicine, Zhejiang university
General Considerations




Endometrial carcinoma is one of the most three
common pelvic genital cancer in women.
It is malignant epithelioid tumor.
The incidence of endometrial cancer has now
raised.
The peak incidence of onset is in the age 58-61
years.
Etiology
Etiology of endometrial carcinoma may involve
two mechanisms
 estrogen-dependent
 estrogen-independentcertain
Pathology





Endometrioid adenocarcinoma
Serous adenocarcinoma
Clear cell carcinomas
Mucus adenocarcinoma
Others
METASTASIS



Direct invasion
Lymphatic metastasis
Vascular metastasis(advanced stage)
SYMPTOMS





mostly of the disease occurs in the elder
patients,there is no symptoms at the very
early stage and it is only discovered by
examine.
abnormal vaginal bleeding
vaginal fluiding
pelvic pain
weakness, weight loss, and anemia
SIGNS



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 of metastasis can be found of the
late stages of the disease
Diagnosis

History：clinical representation and high risk
factor, family history





vaginal bleeding
High-risk factors
Long term use of E2,TAM
Family history of breast cancer and endometrial
carcinomas
Signs
Special Examinations



Fractional curettage
Endometrial biopsy
Endocervical curettage
Diagnose of endometrial carcinoma needs
the pathologic results
Special Examinations





Endometrial cytology exam are also used in some
patients
Ultrasonography can be helpful in deciding clinical
staging, In postmenopausal women, 4mm is the cut
off for a normal unilateral endometrial stripe
The function of cavityscopy is controversy
MRI and CT appear to improve the accuracy of
clinical staging and is particularly helpful in
identifying myometrial invasion
Serum CA-125, a well-established tumor marker can
also be useful for endometrial cancer
Differentiation





Dysfunctional uterine bleeding in the
menopause women
Senile vaginitis
Endometrial polypus
Pelvic genital cancer in women
Endometritis in elders
CLINICAL STAGE

According to anatomic sites
Stage I： endometrium
 Stage II： cervix
 Stage III: parametrial，within pelvis
 Stage IV：beyond metastasis

Staging

Clinical staging(FIGO1971)




According to the Fractional curettage and clinical
examination
Pre-operation staging
Used in the patients who treat Radiation as primary
therapy
Surgical-pathological staging (FIGO2009)


the last staging for the patients who choose surgery as the
principal therapy
It is the last staging for the majority
Staging
THERAPY




Treatment plan for endometrial carcinoma
depends on it’s clinical staging and common
condition
Surgery , radiation therapy and drugs are all in use
Primary 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.
THERAPY
Surgical treatment :
 Primary treatment, especially in the early stages
 Purpose


Definitude the staging and prognostic factors
Excise the lesion
SURGICAL TREATMENT
Clinical stage Ⅰ
 Simple hysterectomy and bilateral salpingooophorectomy 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
SURGICAL TREATMENT
The need for lymphadenectomy
Special pathological type
 Greater than 50% myometrial invasion
 Low differentiation（G3）
 > 50％ cavity be involved by the lesion
 Cervical extension

SURGICAL TREATMENT
Clinical stage II
 Radical hysterectomy and bilateral salpingooophorectomy has been recommended
 Pelvic and para-aortic lymphadenectomy is
necessary
 Make sure to obtain peritoneal washings
 Open the uterus in the operation
 Expect the PR and ER receptors.
SURGICAL TREATMENT
Clinical stage Ⅲ，Ⅳ
cytoreductive surgery should be attempted
if possible
RADIATION THERAPY

Radiation therapy simply is used in patients
with operation forbiddance or in the late
stages.

Postoperative adjuvant radiation therapy is
indicated in patients with
extrauterine extension
lower uterine segment or cervical involvement
myometrial invasion >1/2
poor histologic differentiation
papillary serous or clear cell histology
RADIATION THERAPY


Adjuvant radiation therapy preoperatively is
indicated in reducing tumor size to create
operation condition and eliminate the hiding
metastasis lesion.
Radiation therapy can be carried out inside or
outside body.
HORMONE THERAPY


Progesterone has been the treatment of
recurrent endometrial carcinoma not amenable
to irradiation or surgery. Patients who are young
also use progesterone therapy to keep fertility.
The drugs are manual composed with high dose.
curative effect should be estimated every 2-3
months
Tamoxifen has been used as another hormonal
agent in advanced or recurrent endometrial
cancer
ANTITUMOR CHEMOTHERAPY

Chemotherapy of single drug or
combined drugs is appropriate in the
advanced or recurrent endometrial cancer.
Follow-up


Time ：
2-3rd year: once every 3 months
3-5th year: once every 6 months
>5th year: once every year
Content ：
pelvic examination
cytological exam of the residual vagina
chest X-Ray, CA125