The document discusses endometrial cancer. It notes that the incidence is highest among white populations in the US and lowest in India and Japan. Unopposed estrogen stimulation is the main risk factor. Risk increases with late menopause after age 52, obesity, family history of certain cancers, and nulliparity. Symptoms include postmenopausal bleeding, irregular bleeding, and abnormal discharge. Diagnosis involves endometrial biopsy and imaging tests. The cancer spreads locally within the uterus first and then can spread to lymph nodes or distant sites like lungs and liver.
8. Common in unmarried
In married – asso with nulliparity
Corpus Cancer Syndrome – obesity, HTN, DM
9. Obesity high free oestradiol which is
due to decreased SHBG
Unopposed oestrogen stimulation (Ovarian
tumours, PCOS)
10. Family history or personal history of colon, ovarian or
breast cancer increases the risk of endometrial cancer.
11. Fibroid is associated in about 30 percent cases.
Endometrial hyperplasia precedes carcinoma in about 25 percent
cases.
12. Naked eye—The uterus may be smaller, normal or even enlarged.
Two varieties are found:
Localised on the fundus sessile/pendulated. Myometrium
involvement is late.
Diffuse through endometrium then myometrium (commonly)
reaches the serosal coat.
14. Direct: It is slow growing, it is confined to the stroma for
a long time but eventually, it spreads in all directions.
Thus, it may infiltrate the myometrium and spread to the
parametrium or into the peritoneal cavity.
15. Lymphatic: The lymphatic spread is usually late.
Lymphatic spread involves pelvic, paraaortic (through
infundibulopelvic ligament) and rarely inguinal and
femoral (through lymphatics of round ligament) nodes.
16. Hematogenous: Blood borne spread occurs late. The
common sites of metastases are lungs, liver, bones and
brain.
17.
18. Usually a nullipara, likely to be postmenopausal.
There may be history of delayed menopause.
She may be obese; likely to have hypertension or diabetes
20. In Premenopausal women irregular & excessive bleeding.
There is watery and offensive discharge due to pyometra.
Pain is common. It may be colicky due to uterine contractions in an
attempt to expel the polypoidal growth.
Few patients (< 5%) remain asymptomatic.
21. Speculum examination reveals the cervix looking healthy and the
blood or purulent offensive discharge escapes out of the external os.
Bimanual examination reveals—The uterus is either atrophic,
normal or may be enlarged due to spread of the tumor, associated
fibroid or pyometra.
The uterus is usually mobile unless in late stage, when it becomes
fixed.
22. Endometrial biopsy
Pap Smear +ve only in 30% so not a reliable
Ultrasound and Colour Doppler ET, Hyperechoic endometrium with
irregular outline. Increased vascularity. Intrauterine fluid.
Hysteroscopy direct visualisation of endometrium and targeted
biopsy
Fractional Curettage to know the extent of growth.
CT scan of abdomen and pelvis Lymph nodes
MRI myometrial invasion
PET differentiate between normal and cancerous tissue.