ENDOMETRIAL (Uterine) CANCER
 Cancer of the uterine endometrium (fundus
or corpus) is the fourth most common
cancer in women.
 Adenocarcinoma is the most common type,
accounting for 80% of all cases.
✔ It is slow growing with initial growth in the
uterine cavity, followed by extension into the
myometrium and cervix.
 Type 1, which accounts for the majority of
cases, is estrogen related and occurs in
younger, obese, and perimenopausal
women. It is usually low grade and
endometrioid.
 Type 2, which occurs in about 10% of
cases, is high grade and usually serous
cell or clear cell. It affects older women and
African American women.
 Type 3, which also occurs in about 10% of
cases, is the hereditary or genetic types,
some of which are related to the Lynch II
syndrome.
Discussions: Lynch II syndrome. This
syndrome is associated with the occurrence of
breast, ovarian, colon, endometrial, and other
cancers throughout a family.
Risk Factors
 Prolonged exposure to estrogen without the
protective effects of progesterone.
 Women in reproductive years.
 Family history of endometrial cancer or
hereditary nonpolyposis colorectal cancer
(HNPCC)
 Diabetes mellitus > Nulliparity
 Hypertension > smoking
 Obesity > Late menopause
 Tamoxifen (Nolvadex) give5 n for breast
cacner
Clinical Manifestations
 Irregular bleeding and postmenopausal
bleeding raise suspicion of endometrial
cancer.
Assessment and Diagnostic Methods
 Annual checkups and gynecologic
examination.
 Endometrial aspiration or biopsy is
performed with perimenopausal or
menopausal bleeding.
 Ultrasonography.
Assessment
 Obtain patient information
 Age and ethnicity
 Risk factors of family history of cancer
 History of diabetes, obesity or
hypertension
 Childbearing status, pregnancies, births,
infertility
 Prolonged estrogen use
 Obtain patient information
 Age and ethnicity
 Risk factors of family history of cancer
 History of diabetes, obesity or
hypertension
 Childbearing status, pregnancies, births,
infertility
 Prolonged estrogen use
Surgical Management
 Surgical removal and cancer staging of the
tumor is first-line therapy. Typically, a total
abdominal hysterectomy is done.
Nonsurgical Management
 Radiation therapy and chemotherapy are
used postoperatively and depend on the
surgical staging.
 When Intracavitary radiation thehrapy (IRT)
(brachytherapy) is performed, an applicator
is positioned within the uterus through the
vagina. Implement these interventions for
radiation safety and to prevent dislodgment
of either the applicator or the radiation
source:
  Sexual partners cannot “catch” cancer
1. Maintain radiation precautions.  The patient is not radioactive (after the
2. Provide bedrest, laying the patient on her intracavitary radiation source is
back, with her head flat or elevated less removed).
than 20 degrees. Restrict active movement
to prevent dislodgment.
3. Assess for complications including cystitis,
diarrhea, and mucosal or skin irritation.
 Instruct the patient undergoing external
beam radiation to:
1. Observe for signs of skin breakdown.
2. Avoid sunbathing.
3. Do not remove the markings that outline
the treatment site.
4. Recognize the complications of
treatment, including cystitis, diarrhea,
and nutritional alterations.
5. Recognize the reactions to RT vary
among patients and that some may feel
unclean or radioactive after treatments.
 General management issues for the care of
patients undergoing intracavitary
(brachytherapy) or external (teletherapy)
RT
 Chemotherapy is used as palliative
treatment in advanced or recurrent
endometrial cancer.
1. Chemotherapuetic agents frequently used
include doxorubicin (Adriamycin), cisplatin
(Platinol), paclitaxel (Taxol).
2. General management issues for the car of
patients receiving combination
chemotherapy
Community-based Care
 Provide oral and written instructions on:
 Effects or complications from surgery,
radiation, or chemotherapy that should
be reported to the provider, including
vaginal bleeding, rectal bleeding, foul-
smelling discharge, abdominal pain or
distention, and hematuria
 Dosages, scheduling, and side effects of
prescribed drugs
 Inform the patient that:
 High-dose radiation causes sterility.
 Vaginal shrinkage or dryness can occur
with radiation and chemotherapy