Endometrial Cancer L

ENDOMETRIAL CANCER

INTRODUCTION Endometrial cancer is one of the three main malignant tumors,usually occurs between 58~61 years old. Accounts for about 7% of female malignant tumors,and 20%~30% of female malignant tumors in reproductive system

I.Etiology:not very clear i.long term and continuous stimulation of estrogen on endometrium ii.over hyperplasia of endometrium iii.constitutional factors(obesity) iv.postponed menopause v.hereditary factor:20% has family history

II.Pathology i.macroexamination diffused type localized type ii.microscopic examination (1).endometrioid adenocarcinoma(80%) histological grade G1:nonsquamous solid growth≤5% G2:nonsquamous solid growth 6%~50% G3:nonsquamous solid growth ＞ 50%

(2).adenocarcinoma with squamous differentiation

III.Metastatic path i.directly spreading ii.lymphetic metastasis iii.blood metastasis

IV.Clinical stage For non-operative patient we adopt FIGO(1971) clinical stage. For patient who has accepted operation,we adopt FIGO(1988) operative-pathologic stage. Clinical stage of endometrial cancer(FIGO 1971) Stage 0 adenomatoid hyperplasia or carcinoma in situ Stage I cancer is located in the uterine cavity Ia

the length of uterine cavity≤8cm

Ib

the length of uterine cavity>8cm according to the histological differentiation,Ia and Ib

is also divided into 3 sub-grades:grade1 means welldiferentiated adenocarcinoma;grade2 means moderate differentiation;grade3 means undifferenatiated carcinoma Stage II cancer has spreaded to cervix Stage III cancer spreading is beyond uterus but not beyond the true pelvis Stage IV cancer spreading is beyond true pelvis or involving mucosa of bladder or rectum IVa cancer spreads to nearby organs,such as bladder or rectum IVa cancer has telemetastasis

Operative-pathologic stage of endometrial carcinoma (FIGO 1988) Stage Ia G123 cancer is located in the endometrium Stage Ib G123

there is myometrial invasion and

Stage Ic G123

≤1/2 the myometrial invasion>1/2

Stage IIa G123

cervical gland is involved

Stage IIb G123

cervical stroma is involved

Stage IIIa G123 cancer invades uterine serosa and (or) adnex, and(or) abdominal cavity cytologic examination is positive Stage IIIb G123 vaginal is involved Stage IIIc G123 there is pelvic and (or) para-aortic stageIVa G123

lymphenodes metastasis the bladder and (or) rectum mucosa

stageIVb G123

is involved there is telemetastasis which includes abdominal cavity and (or) inguinal （腹股沟） lymphe nodes metastasis

V.Clinical manifestation i.symptoms (i).vaginal bleeding (postmenopausal) (ii).vaginal discharge (iii).pain (iv).general symptoms ii.body signs at early stage→with the further development → at late stage →if there is uterine empyema( 积脓） → if there is parauterine invasion

VI.Diagnosis:apart from the history,symptoms and body signs,the final confirmed diagnosis is based upon the pathologic results of fractional curettage i.history:means the etiologic factors ii.clinical manifestation: include symptoms and body signs iii.fractional curettage iv.other accessory examination (i).cytologic examination (ii).B-ultrasound (iii).hysteroscopy (iv).MRI,CT,lymphography and CA-125

VII.Differential diagnosis i.dysfunctional uterine bleeding in transitional period of menopause ii.senile vaginitis iii.submucous myoma or endometrial polyp iv.primary fallopian tube cancer v.senile endometrial inflammation complicated with uterine cavity mpyema vi.cervical canal cancer

VIII. Treatment:the determination of treating method i.surgical treatment: the first selected method (i).stage I :Toral hysterectomy and bilateral adnexectomy. Indication of pelvic and para-aortic lymphadenectomy (ii).stage II :Radical hysterectomy and pelvic and paraaortic lymphadenectomy

ii.operation plus radiotherapy (i).postoperative radiotherapy:stage I (ii).preoperative radiotherapy:stage II and III

iii.radiotherapy: for senile patients or with severe complications which can not stand operation or stage III,IV cancer which do not fit for the operation

iv.progesterone treatment (i).indication of progesterone therapy (ii).mechanism of progesterone therapy v.antiestrogen drug therapy vi.chemotherapy:for late stage or recurrent cancer which do not fit for the operation

IX.Follow up Follow up should take regularly after treatment and determine whether there is recurrence. Follow up time:within 2 years after operation,once every 3~6 month;3~5 years after operation ,once a time every 6~12 month. The content of follow up include pelvic examination,Vaginal cytologic smear, chest x-ray and CA-125.

X.Prevention The methods of prevention and early diagnosing Endometrial cancer includes: 1.popularization of Cancer prevention knowledge and take cancer Prevention examination regularly. 2.mastering the Indication of using estrogen. 3.the endometrial cancer Should be suspected firstly in premenopausal women With menstrual disturbance or irregular vaginal bleeding. 4.there is possibility of endometrial cancer In postmenopausal women with vaginal bleeding 5.high risk factors and high risk patient should be paid attention to

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