Endometrial cancer, EC

Notes
  • This is the cancer that occurs in the endometrial lining of the uterus.
  • There are 2 types of EC;

_Type 1

♦This is the most common form of EC.

♦It is an estrogen-dependent neoplasm that begins as proliferation of normal tissues to hyperplasia and then eventually to cancer.

_Type II

♦It is unrelated to estrogen and hyperplasia.

♦It is a more aggressive tumor than Type 1  

  • EC is also sub-dividedk into 2 histological subtypes;

_Endometroid (which is a ciliated adenocarcinoma with a prevalence of 75 – 80%).

_Papillary (which has poor prognosis, acts like ovarian cancer and it is manifested in stage IV of EC)

  • Statistics: Life-time risk for women -3%; average age of diagnosis of EC - > 50 yrs (in 80% of all cases)
Symptoms
  • Abnormal vaginal bleeding in > 90% of all cases (occurs at the early stages of cancer hence most of ECs are diagnosed early). It includes:

_Metrorrhagia (bleeding between menstrual cycle).

_Menorrhagia (heavy menstrual bleeding)

_Watery  blood-tinted discharge in between menstrual periods.

_Bleeding after menopause

  • Pelvic pain or cramping
  • Dyspareunia (pain during intercourse)
  • Pressure in the abdominal area
  • Enlarge lymph nodes
  • Abnormal PAP smear (though not diagnostic).
  • Abnormal glandular cells of unknown significance (AG-CUS)
Diagnosis
  • Laparoscopy and biopsy (and staging)
  • Dilation and Curettage (D & C) hysteroscopy (if endometrial biopsy is not successful)
Differential
  • Endometrial hyperplasia
  • Endometrial / cervical polyps
  • Atrophic endometritis
  • Atrophic vaginitis
  • Coagulopathy
Prevention
  • There are no definitive measure to prevent EC.
  • Early pregnancy, exercises and contraceptives can reduce the prevalence though to a small extent.
Management
  • Surgery;

_Total abdominal hysterectomy (TAH)

_Bilateral salpingo-oophorectomy

_Pelvic and para-aortic lymphadenectomy

_Peritoneal washings for cytology

  • Adjuvant therapy after surgery;

_Radiation therapy (internal and external) for Stage 1-II

_For Stage III-IV: external radiation; hormonal therapy (mainly progestin therapy).

_Chemotherapy: doxorubicin, cisplatin, carboplatin and paclitaxel

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