Endometrial carcinoma 




Prof. Dr. Ayla Khedher
Ghalib
● 4.
Uterine polyp:- Either pedunculated or
sessile insensitive to cyclical hormonal
changes and doesn’t shed at time of
menstruation, it is present in 25% of
women with abnormal uterine bleeding
and in patients taking HRT and
tamoxifen.

Diagnosis and treatment by hysteroscopy

and send for histopathology
( hyperplasia )
● Endometrial carcinoma
Endometrial carcinoma:

Endometrial cancer is becoming most

common gynecologic malignancy in
developed world . Endometrial cancer
affects mainly postmenopausal women
which is present in approximately 10%
of patients referred with PMB.
but 20% occur in premenopausal women
Risk factors:
excess estrogen, either from exogenous
or endogenous sources. Increased
exogenous exposure may be due to
estrogen replacement therapy or
tamoxifen. Increased endogenous
estrogen exposure may result from
o b e s i t y, a n o v u l a t o r y c y c l e s , o r
estrogen-secreting tumors, early
menarche and late menopause.
Risk factors:
1.HRT
2. Diabetes mellitus and hypertension.
3. Use of Tamoxifen agonist effect on
endometrium and antagonist on breast
4. Obesity.
5. Anovulation.
6.Genetic *non polyposis colonic carcinoma,
they are also liable for ovarian carcinoma*
7. Diet.
8. Protective role of OCP.
9.Pcos
Simple hyperplasia without atypia can
be reversed to normal with progestin
therapy

Complex (adenomatous) hyperplasia

without atypia is also generally benign,
the rate of malignancy is less than 3%

Hyperplasia with cytologic atypia is

associated with progression to well-
differentiated adenocarcinoma in 46%
Histopathology :

The most common type of endometrial

cancer is endometrioid
adenocarcinoma 50-60% then
adenosquamous 6-8%. Other types
serous papillary and clear cell
carcinoma.
CLINICAL PRESENTATION:

The classic symptom of endometrial

carcinoma is abnormal uterine bleeding;
such as postmenopausal bleeding unrelated
to hormone therapy. Pre- and
perimenopausal women with
menometrorrhagia and intermenstrual
bleeding also should be evaluated,
particularly if they have other risk factors for
anovulation.
Endometrial cancer should be suspected
when atypical endometrial cells are
found in the Pap smear of a
nonpregnant woman of any age or
when normal endometrial cells are
found in a postmenopausal woman not
taking estrogens.
DIAGNOSIS :

1. Transvaginal ultrasound can be used to

evaluate the endometrium. In
postmenopausal women, an
endometrial thickness of less than 4 to
5 mm is associated with a low risk of
endometrial disease; a thicker lining
should be further evaluated by
endometrial sampling.
2. If high-risk factors are present and the
cause of the bleeding remains
undiagnosed, a fractional D&C should
be completed.

3. Hysteroscopic sampling is best method

EVALUATION AND STAGING :
The preoperative evaluation of women with
confirmed endometrial cancer includes a
complete blood count, electrolytes, renal
function, liver function tests, urinalysis,
chest X-ray, and electrocardiogram.
A CT scan and MRI is usually unnecessary
unless there is suspicion of extra-pelvic
disease, such as in the presence of
intestinal symptoms or more extensive
disease on examination.

Endometrial carcinoma is surgically staged

according to the revised International
Federation of Gynecology and
Obstetrics (FIGO) classification system.
Staging of endometrial carcinoma

Stage 1: tumour limited to
endometrium and myometrium
Stage 2: cervical involvement
Stage 3: tumour invades serosa ,or
adnexia, vagina, pelvic lymph nodes and
or para –aortic lymph nodes
Stage 4: tumour invades bladder and or
bowel mucosa or distant metastases
including abdominal metastases and or
inguinal lymph nods
Treatment;


Stage 1, is by TAH+BSO followed by

radiotherapy either locally to vagina
vault or external beam therapy. Or both
in high grade disease. Adjuvant therapy
is not indicated in grade 1 or 11 tumour
less than 50% myometrial invasion.

Progesterone therapy also used to

reduce the recurrence
The BSO is performed to exclude the
possibility of micrometastases to the
adnexa and to remove the ovaries as a
potential source of estrogen
production.
Pelvic and paraaortic lymph nodes are
sampled intraoperatively to assess
prognosis and determine the need for
postoperative adjuvant therapy.
Stage 2: Radical hysterectomy + BSO
followed by radiotherapy

Stag 3: if disease confined to pelvis (by

C.T scan) radiation therapy is treatment
of choice

Stage 4: Radiotherapy, cytotoxic therapy

and hormonal therapy may be required
Surgery remaines the primaryintervention
inendometrial cancer with better survival
outcome.

Hormone therapy: Cancers associated with

a high progesterone receptor
concentration are associated with a better
prognosis. medroxyprogestern acetate
Chemotherapy. The most effective regimen
includes cisplatin and doxorubin.
Hormonal and chemotherapy used when
there is distant metastases
Prognostic factors:
Prognosis is determined by the surgical
stage of disease and tumor pathology.
Bad prognostic factors are:
• High grade histology
• Invasion to the outer one-half of the
myometrium
• Involvement of the lymphovascular
space

Serous or clear cell histology

Tumor diameter greater than 2 cm or
filling the endometrial cavity
Tumor extension beyond the uterine
fundus (eg, lower uterine segment,
cervix, adnexa, or pelvis).
Follow up: Clinical follow-up should focus
on signs or symptoms that suggest
recurrence: vaginal bleeding, abdominal
or pelvic pain, persistent cough, or
unexplained weight loss.
Physical examination every three to six
months for two years, then annually
Vaginal cytology every six months
for two years, then annually
● Treatment of relapsed endometrial
cancer depends on ;
● 1.site ofdisese relapse ,wether
localized or multiple
● 2.Prior exposure to non surgical
interventions
● 3.Physical condition of the patient
● The commenest site of relapse is
vaginal vault, radiation is the first
intervention if the primary treatment
was surgery
● Ifthe disease is localizedand the
patient has previously undergone
radiotherapy then surgical excision
(partial vaginectomy)

● Ifthrer is distant metastases then

systemic tratment is indicated
depending on the physical condition of
the patient wether chemotherapy or
hormonal therapy
 5 year survival for women with
endometrial cancer. survival
%
Stage 5 year –
1 88
2 75
3 55
4 16