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Uterus video
1. Cancer of the Uterus or
Endometrium
Robert Miller MD
www.aboutcancer.com
2. Uterine cancer is the most common gyn
malignancy with a 2.6 % lifetime risk
The average age is 61 years. The majority are
diagnosed at an early stage (68 percent)
6. PET Scans may be more useful than CT
scans in GYN cancers
7. Endometrial cancer – adenocarcinoma of the
lining of the uterus
1. Ovary, 2. Endometrial Cancer, 3. Uterus, 4. Urinary Bladder, 5.
Rectum, 6. Vagina
8. Prognostic Factors in Endometrial Cancer
Stage (has it spread to the cervix,
ovaries or lymph nodes)
Muscle Invasion (deep invasion in more
serious)
Grade (higher grade is more serious)
Histology (certain types like serous
cancer or sarcoma are more serious)
9. T and N Stage of Uterine Cancer
T1: confined to the uterus
T1a : less than halfway into muscle
T1b: deeper than half
T2: into cervix (stromal connective tissue)
T3a: into serosa or adnexa
T3b: into vagina or parametrium
T4a: into bladder or rectum
N1: pelvic nodes
N2: para-aortic nodes
10. Stages of Uterine Cancer
Stage I (T1N0)
Stage II (T2N0)
Stage IIIa (T3aN0)
Stage IIIb (T3bN0)
Stage IIIC1 (T1-3N1)
Stage IIIC2 (T1-3N2)
Stage Iva (T4)
Stage IVb (M1)
17. 5 Year Survival for Endometrial Cancer
based on the histology of the cancer
18. Treatment of Endometrial Cancer
For most stages surgery (hysterectomy, TAH-BSO-
PPLND) is performed and postOp radiation is
indicated for high risk features:
•Deep muscle invasion (stage T1b)
•Involvement of cervix (stage T2)
•Spread to nodes, ovaries or tubes (Stage T3)
•High risk pathology: high grade, vascular invasion, serous
or clear cell
19. Adverse prognostic factors are used to stratify women with intermediate-
risk endometrial cancer:
•outer one-third myometrial invasion
•grade 2 or 3 differentiation
•lymphovascular invasion within the cancer.
High-intermediate risk – This is based on a combination of age and
number of prognostic factors present:
•Patients of any age with all three factors
•Patients 50 to 69 years old with two factors
•Patients 70 years or older with only one factor
30. Computer reconstruction of radiation fields to
cover groin and pelvic lymph nodes but avoid
the bladder and rectum in vulva cancer patient
31. Combine a CT scan and linear accelerator to ultimate in
targeting (IGRT) and ultimate in delivery (dynamic, helical
IMRT) ability to daily adjust the beam (ART or adaptive
radiotherapy)
33. HDR = high dose rate machine that can run
radiation through a tube that reaches the
patient through vaginal applicators
34. Internal radiation devices
Procedure can be performed in
hospital and the patient stays over
night using a Cesium isotope
applicator or the procedure can be
done as an outpatient with a faster
technique (called high dose rate or
HDR) using an Iridium isotope source
(Iridium 192 with half life of 74 days)
35. Vaginal cylinder is
inserted into the
vagina, the radiation
tube or wire stays
inside the tube and
doesn’t touch the
patient’s skin
36. A Wire or Tube connects the vaginal cylinder
the machine that holds the radioactive
(Iridium) source
37. The woman lays on the radiation table and the treatment
usually takes about 5 minutes and then the cylinder is
removed
38. PostOp radiation for endometrial cancer is
generally vaginal vault cylinder with HDR
46. Side Effects of Vaginal Cylinder
HDR Radiation
•Vaginal irritation or
discharge
•Bladder irritation or
frequency
•Bowels more
frequent, soft or mild
rectal irritation
47. Cancer of the Uterus or
Endometrium
Robert Miller MD
www.aboutcancer.com