Endometrial Cancer

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Endometrial Cancer

• District 1 ACOG Medical Student Teaching Module
  2009

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Symptoms

• Post menopausal bleeding
• Endometrial cells on Pap
• Perimenopausal with irregular heavy menses,
  increasingly heavy menses
• Premenopausal with abnormal uterine bleeding with
  history of anovulation

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Differential Diagnosis for PMB

• Exogenous estrogen use- ie tamoxifen
• Atrophic endometritis/vaginitis
• Endometrial/cervical polyps
• Endometrial hyperplasia
• Endometrial Cancer
• Other gynecologic cancers

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Risk factors for Endometrial Cancer

• Increased estrogen
• Hormone therapy
• Obesity
• Anovulation/PCOS
• Estrogen secreting tumors
• Older age
• Infertility
• Early menarche
• Late menopause
• Genetics
• HNPCC
• Caucasian

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Preoperative Work-up

• Endometrial biopsy
• Ultrasound
• For suspected advanced stage may need
• Cystoscopy
• Sigmoidoscopy
• Pelvic and Abdominal CT
• Labs
• CBC
• Chem 7
• Liver function tests
• EKG, CXR

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Endometrial Hyperplasia (EIN)

• Precursor to endometrial cancer
• Risk of progression related to cytologic atypia
• Presents with abnormal bleeding
• Simple
• Benign irregular dilated glands
• No atypia 1 progress
• Atypia 8 progress
• Complex
• Proliferation of glands with irregular outlines,
  back to back crowding of glands, but no atypia
• No atypia 3 progress
• Atypia 29 progress

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Staging of Endometrial Cancer

• I Confined to uterine corpus
• IA limited to endometrium
• IB invades less than ½ of myometrium
• IC invades more than ½ of myometrium

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Staging of Endometrial Cancer

• II invades cervix but not beyond uterus
• IIA endocervical gland involvement only
• IIB cervical stroma involvement

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Staging of Endometrial Cancer

• III local and/or regional spread
• IIIA invades serosa/adnexa, or positive cytology
• IIIB vaginal metastasis
• IIIC metastasis to pelvic or para-aortic lymph
  nodes

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Staging of Endometrial Cancer

• IVA invades bladder/bowel mucosa
• IVB distant metastasis

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Five Year Survival

• Stage I 81-91
• 72 diagnosed at this stage
• Stage II 71-78
• Stage III 52-60
• Stage IV 14-17
• 3 diagnosed at this stage

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Spread Patterns

• Direct extension
• most common
• Transtubal
• Lymphatic
• Pelvic usually first, then para-aortic
• Hematogenous
• Lung most common
• Liver, brain, bone

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Treatment

• Stage IB or less total hyst/BSO/PPALND, cytology
• Stage IC to IIB total hyst/BSO/PPALND, cytology,
  adjuvant pelvic XRT
• Stage III total hyst/BSO/PPALND, cytology,
  adjuvant chemotherapy
• Stage IV palliative XRT and chemotherapy

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Histologic Types

• Estrogen dependent
• Endometrioid- most common
• Non estrogen dependent- worse prognosis
• Papillary Serous
• Clear cell
• Adenosquamous
• Undifferentiated

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Other Types of Uterine Cancer

• Leiomyosarcoma
• Rapidly growing fibroid should be evaluated
• Stromal sarcoma
• Carcinosarcoma (MMMT)

MMMT
leiomyosarcoma