f-perez-lopez-endometrial-cancer-others-1.pptx

Signs and symptoms
Cause
Types
Etiology
Pathogenesis
Treatment

1. Endometrial CANCER Singh Rahul Group 1807

2. Cancer and menopause Menopause is not associated with increased cancer risk However, cancer rates increase with age and cancer is the second leading cause of death in women Special attention should be provided about oncologic issues during the second half of life

3. Endometrial cancer It is the most common gynecological cancer It occurs most often in postmenopausal women, with less than 5% diagnosed under 40 years of age There is no effective screening program, but occasionally cervical smears contain endometrial cells or double ultrasound endometrial thickness of 4 mm or more indicating the need for endometrial sampling

4. Age Family history of endocrine-related cancers (breast, ovary) Previous breast or ovarian cancer Endometrial hyperplasia in the past Radiation therapy to the pelvis High number of menstrual cycles (early menarche, late menopause) Polycystic ovarian syndrome Nulliparity Infertility or failure of ovulation Unopposed estrogen therapy Tamoxifen treatment Diabetes Obesity Sedentarism Metabolic syndrome Diet high in animal fat Risk factors for endometrial cancer

5. Pregnancies Physical activity Use of oral contraceptives Use of IUD Smoking Protective factors for endometrial cancer

6. Symptoms of endometrial cancer N on-menstrual bleeding or discharge Especially post-menopausal bleeding Heavy bleeding Dysuria Pain: During intercourse (dyspareunia) Pain and/or mass in pelvic area Back pain Weight loss

7. Endometrial cancer diagnosis Pelvic examination Pap smear (may detect cancer spread to cervix) Transvaginal ultrasound Endometrial sampling (hysteroscopy) or curettage is mandatory

8. Who needs a biopsy ? Postmenopausal bleeding Perimenopausal intermenstrual bleeding Abnormal bleeding with history of anovulation Postmenopausal women with endometrial cells on PAP Thickened endometrial stripe via sonography

9. Histopathology Endometrioid adenocarcinoma (70-80%) Clear cell and serous tumor are more aggressive and probably present at a more advances age (8-12%) Adenosquamous (4%) Mucinous (2%) and others

10. Type I Estrogen-related Younger and heavier patients Low grade Background of hyperplasia Perimenopausal Exogenous estrogen Type II (~10% of total cases) Aggressive High grade Unfavourable histology Unrelated to estrogen stimulation Occurs in older and thinner women Endometrial cancer: Type I and II Familial/genetic (~15% of total cases) Lynch II syndrome/HNPCC Familial trend HNPCC = Hereditary Non-Polyposis Colon Cancer

11. Genetic syndromes : HNPCC (Lynch síndrome) Autosomal dominant inheritance MMR (mismatch repair) mutations hMSH2 (chromosome 2) hMLH1 (chromosome 3) Early age of colon cancer: mean 45 years Endometrial cancer: second most common malignancy 20% cumulative incidence by age 70 Earlier age of onset than sporadic cancer Other: ovary (3.5-8 fold), stomach, pancreas, etc

12. Endometrial cancer treatment Surgery Hysterectomy Salpingo-oophorectomy Pelvic lymph node dissection Radiation therapy Hormone therapy: progestogens, antiestrogens Chemotherapy

13. Overall results The overall results are better than for cervix carcinoma, not because it is less malignant, yet because treatment is received earlier Postmenopausal bleeding is much more difficult to ignore than the irregular bleeding of younger woman Cancer dissemination seems to be more rapid for cervix carcinoma than for endometrial spread

14. Recurrence of endometrial cancer The incidence of recurrence within 5 years is in the range of 20 to 30%, depending on the stage at diagnosis, treatment and individual characteristics The majority recurrences appear within 3 years of treatment. Early recurrence has a poor prognosis

15. Progestogens Many endometrial cancers are hormone dependent and progestogens have been used as part of a combined primary treatment as well as for recurrent or metastatic growths Between 15% and 50% recurrences respond to medroxyprogesterone, with or without tamoxifen

16. Uterine sarcoma Accounts for fewer than 10% of all corpus cancers Abnormal vaginal bleeding the most frequent presenting symptoms for all histologic types Types: carcinosarcoma (60%), leiomyosarcoma (30%), endometrial sarcoma (10%), and adenosarcoma (<1%)

17. Uterine sarcomas: general characteristics Exposure to radiation may enhance the development of uterine sarcomas (seen mainly in mixed sarcomas) Mean age 65-75 for carcinosarcoma but earlier for leiomyosarcoma and endometrial stroma sarcoma Early hematogenous spread to liver and lung is common In patients without extrauterine disease, 40% chance of distant recurrence

18. Uterine sarcomas: management Surgery is the hallmark of treatment with hysterectomy and bilateral salpingo-oophorectomy being the standard For patients with advanced or recurrent disease, aggressive surgical intervention is unlikely to influence outcome Adjuvant radiotherapy has been shown to improve local control, effect on overall survival unknown

19. Singh rahul THANKYOU GUYS FOR YOUR ATTENTION