En Dome Trial Carcinoma

ENDOMETRIAL CARCINOMA DR. OKAGUA

ENDOMETRIAL CARCINOMA INTRODUCTION EPIDERMIOLOGY AETIOLOGY PATHOLOGY MODE OF SPREAD STAGING CLINICAL PRESENTATION DIAGNOSIS TREATMENT PROGNOSIS

INTRODUCTION Most common malignancy of the corpus uteri Arises from the lining of the uterus Generally believed to carry good prognosis

EPIDERMIOLOGY AGE – majority > 45yrs median = 61yrs INCIDENCE – varies - highest in white North Americans

AETIOLOGY Endometrial hyperplasia Risk factors

INCREASED RISK FACTORS Obesity especially upper body Impaired carbohydrate tolerance Nulliparity Late menopause Polycystic ovarian syndrome Unopposed oestrogen therapy Functioning ovarian tumours

RISK FACTORS (cont.) Personal history of breast or colon cancer Family history of breast, colon, ovarian or endometrial cancer (Lynch II syndrome) Tamoxifen therapy Previous pelvic irradiation DECREASED RISK Oral contraceptives Progestogens Cigarette smoking

PATHOLOGY MACROSCOPY – raised, rough area often in the fundus of the uterus HISTOLOGICAL SUBTYPES 1. Endometriod adenocarcinoma 2. Adenoacanthoma 3. Adenosquamous carcinoma 4. Papillary serous & clear cell carcinomas

MODE OF SPREAD DIRECT SPREAD – myometrium, cervix (+ parametrium), fallopian tubes, ovaries LYMPHATIC SPREAD – pelvic, paraaortic VASCULAR SPREAD TRANSPERITONEAL SPREAD – via serosal surface or fallopian tubes to peritoneal surfaces and omentum

STAGING (FIGO) Stage I Carcinoma confined to corpus Ia Tumour limited to endometrium Ib Invasion < half of myometrium Ic Invasion > half of myometrium Stage II Invasion of corpus & cervix but not outside the uterus IIa Endocervical glandular involvement only IIb Cervical stromal invasion Stage III Extension outside uterus but not outside true pelvis IIIa Invasion of serosa/ adnexae/ +ve peritoneal cytology IIIb Vaginal metastasis IIIc Metastasis to pelvic and/or para-aortic nodes Stage IV Distant metastasis (excluding bullous oedema) IVa Invasion of bladder and/or bowel mucosa IVb Distant metastasis (+inguinal, intra-abdominal nodes)

CLINICAL PRESENTATION

HISTORY Postmenopausal bleeding (75-80%) Postmenopausal vaginal discharge Pelvic pain Irregular vaginal bleeding/ menorrhagia PHYSICAL EXAMINATION Enlarged groin/supraclavicular nodes Vaginal lesion (metastatic focus) Enlarged uterus Palpable focus in adnexae/parametrium Breast examination (possible site of primary tumour)

INVESTIGATIONS SCREENING Endometrial sampling – endometrial biopsy (Sharman curette, pipelle, z-sampler), aspiration curettage, endometrial lavage, endometrial brush sponge, endometrial aspiration Vaginal or Cervical cytology Vaginal ultrasound scan DIAGNOSIS EUA + Hysteroscopy + D&C under GA ASSESSMENT OF METASTASIS Chest X-ray, IVU, ultrasound, MRI FBC, E/U/Cr, Urinalysis

TREATMENT Stage 1 TAH + BSO (+ Radiotherapy for stage Ic) Stage II - Radical hysterectomy + bilateral pelvic lymphaadenectomy + para-aortic node sampling - Radiotherapy for unfit patients Stage III Surgery + adjuvant radiotherapy Stage IV - Individualized - Usually radiotherapy +/- surgery for residual dx. Recurrent disease - Radiotherapy, progestogens (Rx & Pv), cytotoxics

PROGNOSIS PROGNOSTIC FACTORS Stage of disease Grade of disease Myometrial invasion Tumour size Age General belief that it carries a good prognosis is being disputed. 5yr survival approaches that of Carcinoma of the Cervix