ENDOMETRIAL CANCER -I

DR P.PALLAVEE

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OBJECTIVES

• To be able to identify the risk factors associated with endometrial cancer.

• To understand the pathology of the premalignant stage.

• To be able to manage the premalignant stage of endometrial cancer.

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CONTENTS

• Risk factors of endometrial cancer• Definition of endometrial hyperplasia• Types and malignant potential of

endometrial hyperplasia.• Management of endometrial

hyperplasia.

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FACTS:

• Endometrial cancer is commonest uterine malignancy.

• Commonest gynecological cancer in developed countries.[20-25%]

• In India Cervical cancer commonest.• Median age at presentation is 61 yrs.

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RISK FACTORSENDOGENOUS ESTROGEN EXOGENOUS ESTROGEN

NULLIPARITY HRT

INFERTILITY/PCOS USE OF TAMOXIFEN

EARLY MENARCHE/LATE MENOPAUSE

OBESITY

FUNCTIONING OVARIAN TUMORS

OTHERS- DIABETES, HYPERTENSION, HYPOTHYROIDISM

HEREDITARY NON-POLYPOSIS COLORECTALCANCER SYNDROME

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PREVENTION

• ORAL CONTRACEPTIVE PILLS [ decreases risk by 50 % if taken for

10 yrs and effect lasts for 20 yrs]• USE OF PROGESTOGEN [ regular withdrawal in PCOS

patients]• LIFESTYLE MODIFICATION• [ diet and exercise]2/15/2016

ENDOMETRIAL HYPERPLASIA

• Defined as a proliferation of endometrial glands of irregular size and shape with an increase in the gland stroma ratio.

• Prolonged and unopposed estrogenic stimulation in the absence of progesterone.

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TYPES OF ENDOMETRIAL HYPERPLASIA

• Classified according to complexity and crowding of glandular framework

• Simple hyperplasia• Complex hyperplasia• Atypical hyperplasia- SimpleComplex

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NORMAL ENDOMETRIUM SIMPLE HYPERPLASIA COMPLEX HYPERPLASIA

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ATYPICAL HYPERPLASIA

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MALIGNANT POTENTIAL

• Simple Hyperplasia without atypia- 1%

• Complex Hyperplasia without atypia- 3%

• Simple Hyperplasia with atypia- 8%

• Complex Hyperplasia without atypia- 29%

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Diagnosis

• ULTRASONOGRAPHY• SALINE INFUSION SONOGRAPHY• HYSTEROSCOPY & TARGETED BIOPSY• ENDOMETRIAL BIOPSY-[ PIPELLE]

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TVS SIS

HYSTEROSCOPEPIPELLE2/15/2016

MANAGEMENT1. Depends on patients age, reproductive

status,surgical risk and presence of cytological atypia.

2. Hyperplasia without atypia-• Progestogen- oral MPA, LNG-IUD• Continuous for 3-6 mnths and reassess.3. Atypical hyperplasia• Hysterectomy• Fertility sparing- High dose Progesterone [ 6-43% cases of atypical hyperplasia

may be associated with endometrial carcinoma]2/15/2016

Expected questions

• List the risk factors of endometrial carcinoma.

• Enumerate the types of endometrial hyperplasia.

• Diagnosis and management of endometrial hyperplasia [ viva]

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References • Textbook of Gynecology –Sheila

Balakrishnan• Essentials of Gynecology-

S.Arulkumaran

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THANK YOU

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