Endometrial carcinoma in womennnnnn pptx

Endometrial carcinoma

1. ENDOMETRIAL CANCER Dr. Nishi Tandon Professor Department of pathology

2. INTRODUCTION Malignant epithelial neoplasm originating from the endometrium Most common invasive cancer of the female genital tract Postmenopausal women 6th to 7th decades of life Most common symptom - Abnormal bleeding in postmenopausal woman or excessive flow in the premenopausal years. Most common type – Endometroid type

3. UTERUS Uterus : Myometrium and Endometrium. The myometrium is composed of tightly interwoven bundles of smooth muscle that form the wall of the uterus. The internal cavity of the uterus is lined by the endometrium composed of glands embedded in a cellular stroma.

4. ENDOMETRIUM

5. Endometrial hormonal cycle: Average cycle is 28 days. Proliferave (follicular) portion of the cycle varies among women, but tends to remain the same for any one woman. The time from ovulation to menstruation in the secretory (luteal) portion of the cycle is a constant 14-day period. The menstrual portion of the cycle averages 3 to 7 days. The menstrual cycle is controlled by follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion from the adenohypophysis, which is under negative feedback control by ovarian steroids, mainly estradiol ,.

6. ETIOLOGY The exact etiology of endometrial cancer remains unknown. However, a few factors associated with increased frequency of its development are chronic unopposed oestrogen excess, obesity, diabetes Hypertension Nulliparous state Heredity.

7. contd … Endometrial carcinoma has association with endometrial hyperplasia in which there is unopposed chronic hyperoestrogenism and frequent anovulatory cycles. In postmenopausal years when endometrial carcinoma occurs characteristically, there is excessive synthesis of oestrogen in the body from adrenal as well as from ovarian sources.

8. 3. Women having oestrogen-secreting tumours (e.g. granulosa cell tumour) have increased risk of developing synchronous endometrial cancer. 4. Patients receiving prolonged exogenous oestrogen therapy are at higher risk of developing this cancer. 5. Women of breast cancer receiving tamoxifen for prolonged period have 2-fold increased risk of developing uterine cancer

9. PATHOGENESIS

10. GROSS Polypoid tumor or a diffuse Spread: Direct myometrial invasion to peri-uterine structures Spread to broad ligaments may create a palpable mass. Regional lymph nodes Metastasize to the lungs, liver, bones, and other organs. 

11. Gross contd …

12. ENDOMETRIAL HYPERPLASIA

13. ENDOMETRIAL HYPERPLASIA Endometrial hyperplasia is defined as an increased proliferation of the endometrial glands relative to the stroma It is commonly associated with prolonged, profuse and irregular uterine bleeding in a menopausal or postmenopausal woman. Associated with prolonged estrogen stimulation of the endometrium, due to Anovulation Increased estrogen production from endogenous sources, or exogenous estrogen. Conditions associated with hyperplasia include Obesity, menopause, Polycystic ovarian disease (including Stein- Leventhal syndrome), Functioning granulosa cell tumors of the ovary, Excessive cortical function (cortical stromal hyperplasia), and Prolonged administration of estrogenic substances (estrogen replacement therapy ).

14. ENDOMETRIAL HYPERPLASIA Endometrial cavity is filled with lush fronds of hyperplastic endometrium.

15. Simple hyperplasia without atypia Commonly termed cystic glandular hyperplasia (CGH), Varying-sized glands, many of which are large and cystically dilated and are lined by atrophic epithelium. Mitoses are scanty and there is no atypia Stroma between the glands is sparsely cellular and oedematous

16. Complex hyperplasia without atypia Glands are increased in number, exhibit variation in size and are irregular in shape. The glands are lined by multiple layers of tall columnar epithelial cells with large nuclei which have not lost basal polarity and there is no significant atypia. Papillary infolds or out-pouchings. The stroma dense, cellular and compact.

17. Complex hyperplasia with atypia Atypia (mild, moderate or severe). loss of polarity, large size, irregular & hyperchromatic nuclei, prominentnucleoli, and Altered nucleocytoplasmic ratio About 20-25% cases of untreated atypical hyperplasia progress to carcinoma.

18. A –SIMPLE HYPERPLASIA WITHOUT ATYPIA (Cystic glandular hyperplasia)

19. B -COMPLEX HYPERPLASIA WITHOUT ATYPIA (Complete non atypical hyperplasia)

20. C- COMPLEX HYPERPLASIA WITH ATYPIA (Complex atypical hyperplasia)

21. TYPES OF ENDOMETRIAL CANCER

22. Characteristics of Type1 & 2 endometrial cancer   Characteristics Type I Type II Age 55-65 yr 65-75 yr Clinical setting Unopposed estrogen Atrophy Thin physique Obesity Hypertension Diabetes  Morphology Endometrioid Serous,Clear cell,Mixed müllerian tumor Precursor Hyperplasia Endometrial intraepithelial carcinoma Molecular genetics PTEN, p53 PIK3CA Aneuploid KRAS PIK3CA MSI*   β-catenin   p53  Behavior Indolent Aggressive   Spreads via lymphatics Intraperitoneal and lymphatic spread spread

23. Morphology:   Type I carcinomas Most endometrial carcinomas (about 85%) are endometrioid adenocarcinomas  characterized by gland patterns resembling normal endometrial epithelium. A three-step grading system Well differentiated (grade 1), with easily recognizable glandular patterns Moderately differentiated (grade 2), showing well-formed glands mixed with solid sheets of malignant cells Poorly differentiated (grade 3) characterized by solid sheets of cells with barely recognizable glands and a greater degree of nuclear atypia and mitotic activity .

24. Endometrioid adenocarcinoma

25. Fig A, Fungating mass in the fundus of the uterus.

26. Fig B, Well-differentiated (grade 1) preserved glandular architecture but lack of intervening stroma, distinguishing it from hyperplasia.

27. Fig C, Moderately differentiated (grade 2) glandular architecture admixed with solid areas.

28. Fig D, Poorly differentiated (grade 3) solid growth

29. STAGING The FIGO (International Federation of Gynecology and Obstetrics) staging system for endometrial cancer was updated in 2023. Stage I: Cancer confined to the uterus. - Stage IA: Tumor limited to the endometrium or invading less than half of the myometrium. - Stage IB: Tumor invading half or more of the myometrium. Stage II: Cancer invades the cervical stroma but does not extend beyond the uterus.

30. Stage III : Local and regional spread of the tumor. Stage IIIA: Tumor invades the serosa of the corpus uteri and/or adnexa. Stage IIIB: Vaginal and/or parametrial involvement. Stage IIIC1: Pelvic lymph node involvement. Stage IIIC2: Para-aortic lymph node involvement. Stage IV : Tumor invasion beyond the pelvis or into adjacent organs. Stage IVA: Tumor invades the bladder and/or bowel mucosa. Stage IVB: Distant metastasis, including abdominal and/or inguinal lymph nodes.

31. CLINICAL FEATURES Abnormal uterine bleeding (postmenopausal or irregular in premenopausal women) Pelvic pain or discomfort Pelvic mass (in advanced stages) Postcoital bleeding Unexplained weight loss Vaginal discharge (watery or blood-tinged) Urinary symptoms (frequency, urgency, dysuria)