ENDOMETRIAL CARCINOMA

1. SHRUTHI.S.JAYARAJ,53 RD
CALICUT MEDICAL COLLEGE

2. DEVELOPED COUNTRIES
DEVELOPING COUNTRIES
CA ENDOMETRIUM
CA CERVIX
 POOR HYGEINE
MULTIPARITY
EARLY MARRIAGE

3. 
INCIDENCE IS HIGHEST IN U.S, LOWEST IN
INDIA, JAPAN

PRIMARILY IN POST MENOPAUSAL LADIES
MEAN AGE ~ 60 yrs

4. OESTROGEN
RISK
FACTORS
OTHERS
OBESITY
DIABETES
HYPERTENSION
HNPCC

5. 
EXOGENOUS
HORMONE
REPLACEMENT
THERAPY
 TAMOXIFEN
FOR BREAST
CANCER
ENDOGENOUS
EARLY MENARCHE
LATE MENOPAUSE
PCOS
OBESITY
FUNCTIONING
OVARIAN TUMORS

6.  HORMONE THERAPY FOR POST MENOPAUSAL
LADIES :
‘FEMININE FOREVER’ !!!
OESTROGEN USED ALONE
OESTROGEN + PROGESTINS
RISK
RISK

7. 
SERM
 POTENT ANTAGONIST IN BREAST – Rx of CA
BREAST
PARTIAL AGONIST IN UTERUS
LONG TERM USE- ENDOMETRIAL
PROLIFERATION,CARCINOMA

8.  COMBINED ORAL HORMONAL PILLS HAVE A
PROTECTIVE EFFECT AND REDUSES RISK BY 4050%

9.  OBESITY REDUCES LEVEL OF
SERUM HORMONE BINDING
PROTEIN
FREE ESTROGEN
CIRCULATES IN BODY
 PERIPHERAL FAT : CONVERSION
OF EPIANDROSTENEDIONE TO
OESTRONE

10.  NULLIPAROUS WOMEN & WOMEN WITH PCOD
NON OVULATION
HIGH OESTROGEN
ENDOMETRIAL HYPERPLASIA ENDOMETRIAL
CANCER

11. NULLIPARITY
PCOS
EARLY MENARCHE
LATE MENOPAUSE
TAMOXIFEN
HRT
RISK
FACTORS
OBESITY
DIABETES
HYPERTENSION
LYNCH 2
/ HNPCC

12.  WOMEN WITH FAMILIAL LYNCH 2 SYNDROME
(HNPCC) ARE LIKELY TO SUFFER FROM
ENDOMETRIAL CANCER.

13.  TYPE 1
 TYPE 2

14. TYPE 1
 WELL
DIFFERENCIATED
 GLANDS BACK TO
BACK
 MINIMUM STROMA

15. TYPE 2
 POORLY
DIFFERENCIATED
 PREDOMINANTLY
SOLID PATTERN
 MINIMAL GLAND
FORMATION

16. 55-65 YRS
OESTROGEN DEPENDANT
PREVIOUS H/O EXPOSURE TO UNOPPOSED
OESTROGEN.
a/w OBESITY/HYPERTENSION/DIABETES
‘WELL DIFFERENCIATED’ & MIMICS
PROLIFERATIVE ENDOMETRIAL GLANDS.AS
SUCH,REFERRED TO AS ENDOMETRIOD
CARCINOMA
EXCELLENT PROGNOSIS

17. 65 – 75 yrs
OESTROGEN INDEPENDENT
UNRELATED TO HORMONE EXPOSURE
USUALLY ARISES IN AN ATROPHIC
ENDOMETRIUM
USUALLY UNDIFFERENCIATED & AGGRESSIVE
DEEP MUSCLE INVASION
BAD PROGNOSIS

18. TYPE 1
TYPE 2
 55-65 YRS
 65 – 75 YRS
 ESTROGEN
 ESTROGEN
DEPENDENT
 ENDOMETRIAL
HYPERPLASIA MAY BE
PRESENT
 WELL
DIFFERENCIATED
INDEPENDENT
 USUALLY IN ATROPHIC
ENDOMETRIUM
 UNDIFFERENCIATED

19. TYPE 1
TYPE 2
 STABLE
 AGGRESSIVE
 MINIMAL MUSCLE
 DEEP MUSCLE
INVASION
 HISTOLOGY –
ENDOMETRIOD
 EXCELLENT
PROGNOSIS
INVASION
 HISTOLOGY- SEROUS /
CLEAR CELL
 BAD PROGNOSIS

20.  ENDOMETRIAL CANCER MAY BE : LOCALISED/
DIFFUSE
APPEAR AS :
NODULE
POLYP
DIFFUSE LESION INVOLVING WHOLE
UTERINE CAVITY

21. DIFFUSE

22.  TO THE NAKED EYE THE ENDOMETRIAL
CURETTINGS APPEAR PALE & FRIABLE

HISTOLOGICALLY
75 % ADENOCARCINOMA
REST- SQUAMOUS / SEROUS

23. GRADE 1 : WELL DIFFERENCIATED ADENO CARCINOMA
< 5 % SOLID GROWTH PATTERN
GRADE 2
:
MODERATELY DIFFERENCIATED
ADENOCARCINOMA
6 – 50 % SOLID GROWTH PATTERN
GRADE 3
:
POORLY DIFFERENCIATED ADENOCARCINOMA
> 50 % SOLID GROWTH PATTERN

24. GRADE 1
GRADE 2
GRADE 3

25.  ENDOMETRIOD
 MUCINOUS
 PAPILLARY SEROUS
 CLEAR CELL
 SQUAMOUS
 UNDIFFERENCIATED
 MIXED

26.  ENDOMETRIOD
GOOD PROGNOSIS
 MUCINOUS
 PAPILLARY SEROUS
 CLEAR CELL
 SQUAMOUS
BADPROGNOSIS

27.  COMMONEST TYPE ~ 80 %
 COMPOSED OF GLANDS WHICH RESEMBLE
NORMAL ENDOMETRIAL GLANDS
 WELL DIFFERENCIATED & GOOD PROGNOSIS

28.  5 % OF CANCERS
 HAVE A MUCINOUS PATTERN
 WELL DIFFERENCIATED GLANDULAR PATTERN
 GOOD PROGNOSIS

29.  5 % ALL TUMORS
 EXHIBIT PAPILLARY PATTERN
 BEHAVE AGGRESSIVELY
 POOR PROGNOSIS
 HIGH RISK FOR LYMPHOVASCULAR SPACE
INVOLVEMENT AND DEEP MYOMETRIAL
INVASION EVEN WITH EARLY STAGE DISEASE
 SPREAD EARLY TO ABDOMEN

30.  5 % OF ALL CANCERS
 CELLS LARGE WITH ATYPICAL NUCLEI,CLEAR
CYTOPLASM, CONTAIN GLYCOGEN
 MAY SHOW HOBNAIL CONFIGURATION AND
FORM PAPILLARY STRUCTURES
 HIGHLY AGGRESSIVE
 BAD PROGNOSIS

31. A
B
c

32.  VERY RARE VARIETY
 R/O SPREAD FROM CERVICAL SQUAMOUS
EPITHELIUM
 VERY POOR PROGNOSIS EVEN WITH STAGE 1
DISEASE

33. CLINICAL FEATURES

34.  ASYMPTOMATIC IN 7- 10 %
 MANIFEST AS
MENORRHAGIA & IRREGULAR PERIODS
PERIMENOPAUSAL LADIES
POST MENOPAUSAL BLEEDING IN MENOPAUSAL
WOMAN

35. ELDERLY WITH CERVICAL STENOSIS
HAEMATOMETRA/PYOMETRA
PURULENT VAGINAL DISCHARGE

36.  SOME WOMEN EXPERIENCE PELVIC PRESSURE
AND PAIN DUE TO UTERUS ENLARGEMENT OR
EXTRAUTERINE SPREAD

37.  ADVANCED STAGE-
BULKY CERVIX,
GROWTH
PROTRUDING
THROUGH OS

38. THANK YOU