Kraft Hunor-Norbert, Bartha Edina Kinga, Bereczky L. Katalin, Szabó BélaMarosvásárhelyi Orvosi és Gyógyszerészeti Egyetem, Szülészeti és Nőgyógyászati Klinika

Az endometriumcarcinomaaktuális kérdései

ORVOS- ÉS GYÓGYSZERÉSZ-TUDOMÁNYI SZAKOSZTÁLY

ÜLÉSSZAKTUDOMÁNYOSXXIV.

MAROSVÁSÁRHELY, 2014.

Kikrőlbeszélünk?

GLOBOCAN 2012 - ROMÁNIA

méhnyak13% petefészek

5%méhtest4,3%

80%

FIGO I-esstádium

90%

rendellenes vérzésmiatt jelentkezik

80%

endometrioidtípusú

5%

Lynch szindrómás(HNPCC)

Hannah Arem et al. Prediagnosis Body Mass Index, Physical Activity, and Mortality in Endometrial Cancer Patients - J Natl Cancer Inst. 2013;105(5):342-349.Lindemann K et al. Body mass, diabetes and smoking, and endometrial cancer risk: a follow-up study. - Br J Cancer 2008;98:1582–5.Creasman WT et al. Carcinoma of the corpus uteri. FIGO 26th annual report on the results of treatment in gynecological cancer. - Int J Gynaecol Obstet. 2006;95(Suppl 1):S105–S143.Amant F et al. Endometrial cancer. - Lancet. 2005;366(9484):491–505.

Hányévesek?

65 év

15%

Uharcek P et al. Prognostic factors in women 45 years of age or younger with endometrial cancer. - Int J Gynecol Cancer 18:324–328, 2008Ota T et al. Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger. - Int J Gynecol Cancer. 2005;15(4):657–662.Duska LR et al. Endometrial cancer in women 40 years old or younger. - Gynecol Oncol. 2001;83(2):388–393.

a betegeknagy része

TAH+BSO / RH+BSO+L(laparotómia / laparoszkópia)

fiatalabb ésgyereketszeretne

?

magasműtéti

kockázatú

?

( )

BMI > 30; fehérbőrű; nullipara; PCOS

Lynch szindrómás

fiatalabb és ...

kifejezetten agresszívhamar ráterjed a méhnyakra

nem endometrioid típusúmegelőzés / szűrés!

Dudnyikova Anna et al. Fiatalkori endometriumcarcinoma. Saját anyagunk 17 esetének ismertetése - Magyar Onkológia 57:203–206, 2013Crispens MA Endometrial and ovarian cancer in lynch syndrome. - Clin Colon Rectal Surg. 2012 Jun;25(2):97-102Ketabi Z et al. Ovarian cancer linked to Lynch syndrome typically presents as early-onset, non-serous epithelial tumors. -Gynecol Oncol. 2011;121(3):462–465.Carcangiu M L et al. Lynch syndrome-related endometrial carcinomas show a high frequency of nonendometrioid types and of high FIGO grade endometrioid types. - Int J Surg Pathol. 2010;18(1):21–26Uharcek P et al. Prognostic factors in women 45 years of age or younger with endometrial cancer. - Int J Gynecol Cancer 18:324–328, 2008Soliman PT et al. Risk factors for young premenopausal women with endometrial cancer - Obstet Gynecol. 2005 Mar;105(3):575-80.Soliman PT et al. Women with synchronous primary cancers of the endometrium and ovary: do they have Lynch syndrome? - J Clin Oncol. 2005;23(36):9344–9350.Lu K H et al. Gynecologic cancer as a “sentinel cancer” for women with hereditary nonpolyposis colorectal cancer syndrome. - Obstet Gynecol. 2005;105(3):569–574.Duska LR Endometrial cancer in women 40 years old or younger. - Gynecol Oncol. 2001 Nov;83(2):388-93.

- Grade 1, endometrioid típusú- képalkotó (MR) által bizonyítottan FIGO IA- képalkotó (MR) által bizonyítottan M0- aláírt beleegyező nyilatkozat- nincs a terhességnek egyéb ellenjavallata

Kinél jöhet szóbaa fertilitás megtartása?

American Society of Clinical Oncology Clinical Practice Guideline Uterine Neoplasms, Version 1.2014

Hogyan?PROGESZTERON

6-9 hónapig

kontroll

terhesség

műtét

Kim ML et al. Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases - Obstet Gynecol Sci. Mar 2013; 56(2): 67–75.Heikinheimo O et al. Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS) - Acta Obstet Gynecol Scand. 2012;91:3–9.Gallos ID et al. Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis - Am J Obstet Gynecol. 2012;207:266.e1–266.e12Kesterson JP Fertility-sparing treatment of endometrial cancer: options, outcomes and pitfalls. - J Gynecol Oncol. 2012 Apr;23(2):120-4. Kim MK et al. Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study. - Int J Gynecol Cancer. 2011;21:673–677Cade TJ et al. Progestogen treatment options for early endometrial cancer. - BJOG. 2010;117:879–884.Ramirez PT et al. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. - Gynecol Oncol. 2004;95:133–138.Duska LR Endometrial cancer in women 40 years old or younger. - Gynecol Oncol. 2001 Nov;83(2):388-93.

recidiválsikereskezelés

sikeresterhesség

40%25%40-60%

Eredményes?

Joshua P. Kesterson Fertility-sparing treatment of endometrial cancer: options, outcomes and pitfalls - J Gynecol Oncol. Apr 2012; 23(2): 120–124.Perri T et al. Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved. - Int J Gynecol Cancer. 2011 Jan;21(1):72-8.Ushijima K Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. - J Clin Oncol. 2007 Jul 1;25(19):2798-803.Paulson RJ Pregnancy after in vitro fertilization in a patient with stage I endometrial carcinoma treated with progestins. - Fertil Steril. 1990 Oct;54(4):735-6.

Maradjanak apetefészkek?

25%

szinkron tumor

Walsh C et al. Coexisting ovarian malignancy in young women with endometrial cancer. - Obstet Gynecol. 2005 Oct;106(4):693-9.Soliman PT et al. Women with synchronous primary cancers of the endometrium and ovary: do they have Lynch syndrome? - J Clin Oncol. 2005;23(36):9344–9350.Shannon C et al. Incidence of microsatellite instability in synchronous tumors of the ovary and endometrium. - Clin Cancer Res. 2003; 9(4):1387–1392.

Miért jelentkihívást

az idős kor /az extrémobezitás?

egyébbetegségek

sebgyógyulásiproblémák

laparoszkópiát kellkonvertálni laparotómiává

30’

hosszabbműtéti idő

Royal College of Obstetricians and Gynaecologists Endometrial Cancer in Obese Women - Scientific Impact Paper No. 32 2012Farthing A et al. Total laparoscopic hysterectomy for early stage endometrial cancer in obese and morbidly obese women - J Obstet Gynaecol 2012;6.O’Gorman, T et al. Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical considerations. - European Journal of Gynaecological Oncology, 30, 171-173 May 2012Bijen CB et al. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese. - Eur J Cancer 2011;47:2158–65.Walker JL et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. - J Clin Oncol 2009;27:5331–6.Salani R et al. Surgical Approaches and Short Term Surgical Outcomes for Patients with Morbid Obesity and Endometrial Cancer. - J Gynecol Surg 2009;25:41–8.Association of Anaethetists of Great Britain and Ireland. Peri-operative Management of the Morbidly Obese Patient. - AAGBI: London; 2007.Eisenhauer EL et al. Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy, or laparotomy with panniculectomy for the staging of uterine malignancy. - Ann Surg Oncol 2007;14:2384–91.Pavelka, J.C. et al. Morbid obesity and endometrial cancer: Surgical, clinical, and pathologic outcomes in surgically managed patients. - Gynecologic Oncology, 95, 588-592. 2004

Mi lehet amegoldás?

Onkológiai centrumban történő műtét

Sentinel jelöléscsak alacsony rizikó csoportnál, N0, M0

ultrastageing (megfelelő központ)ki kell venni mindent ami gyanús( )

American Society of Clinical Oncology Clinical Practice Guideline Uterine Neoplasms, Version 1.2014Barlin JN et al. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. - Gynecol Oncol 2012;125:531-5.Chan JK et al. Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer - J Clin Oncol. 2011 Mar 1;29(7):832-8.

Nota bene!

megelőzésés szűrés egy esély centrumba

küldés

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