ENDOMETRIAL CANCER
INTRODUCTION
Endometrial cancer is one of the three main malignant
tumors,usually occurs between 58~61 years old.
Accounts for about 7% of female malignant tumors,and
20%~30% of female malignant tumors in reproductive
system
I.Etiology:not very clear
i.long term and continuous stimulation of
estrogen on endometrium
ii.over hyperplasia of endometrium
iii.constitutional factors
iv.postponed menopause
v.hereditary factor:20% has family history
II.Pathology
i.macroexamination
(i).diffused type
(i).localized type
ii.microscopic examination
(i).endometrioid adenocarcinoma(80%)
histological grade
G1:nonsquamous solid growth≤5%
G2:nonsquamous solid growth
6%~50%
G3:nonsquamous solid growth＞ 50%
(ii).adenocarcinoma with squamous
differentiation
i).adenoacanthoma
ii).adenosquamous carcinoma
iii).adenocarcinoma with squamous
atypical hyperplasia
(iii),clear cell carcinoma (4%)
(iv),serous adenocarcinoma(10%)
III.Metastatic path
i.directly spreading
ii.lymphetic metastasis
iii.blood metastasis
Metastatic Path
1.Directly spreading:cances focus grow on the endometrium and
to fallopian tube,to cervix and vagina,to myometrium and
serous and fallopian tube and ovary.Finally implant on the
pelvic peritoneum,pouch of Douglas and omentum.
2.Lymphatic metastasis:the chief metastatic path.
(1).uterine fundus cancer uper edge of broad ligament
suspend ligament and ovary and paraarotic LN.
(2).uterine corner cancer,along round ligament inguinal LN
(3).lower segment and cervical canal cancer parauterine,inter-
nal iliac,external iliac and common iliac LN,
(4).posterior wall cancer along uterosacral ligament rectal LN
(5).endometrial cancer can also bladder and vagina.
IV.Clinical stage
For non-operative patient we adopt FIGO(1971)
clinical stage.
For patient who has accepted operation,we adopt
FIGO(1988) operative-pathologic stage.
Clinical stage of endometrial cancer(FIGO 1971)
Stage 0 adenomatoid hyperplasia or carcinoma in
situ
Stage I cancer is located in the uterine cavity
Ia the length of uterine cavity≤8cm
Ib the length of uterine cavity>8cm according
to the histological differentiation,Ia and Ib
is also divided into 3 sub-grades:grade1 means well-
diferentiated adenocarcinoma;grade2 means moderate
differentiation;grade3 means undifferenatiated
carcinoma
Stage II cancer has spreaded to cervix
Stage III cancer spreading is beyond uterus but not
beyond the true pelvis
Stage IV cancer spreading is beyond true pelvis or
involving mucosa of bladder or rectum
IVa cancer spreads to nearby organs,such as
bladder or rectum
IVa cancer has telemetastasis
Operative-pathologic stage of endometrial
carcinoma
(FIGO 1988)
stageIa G123 cancer is located in the endometrium
stageIb G123 there is myometrial invasion and
≤1/2
stageIc G123 the myometrial invasion>1/2
stageIIa G123 cervical gland is involved
stageIIb G123 cervical stroma is involved
stageIIIa G123 cancer invades uterine serosa and (or)
adnex,and(or) abdominal cavity
cytologic examin tion is positive
stageIIIb G123 vaginal is involved
stageIIIc G123 there is pelvic and (or) para-aortic
lymphenodes metastasis
stageIVa G123 the bladder and (or) rectum mucosa
is involved
stageIVb G123 there is telemetastasis which
includes abdominal cavity and (or)
inguinal lymphe nodes metastasis
V.Clinical manifestation
i.symptoms
(i).vaginal bleeding
(ii).vaginal discharge
(iii).pain
(iv).general symptoms
ii.body signs
at early stage→with the further
development → at late stage →if there is
uterine empyema →if there is parauterine
invasion
VI.Diagnosis:apart from the
history,symptoms and body signs,the final
confirmed diagnosis is based upon the
pathologic results of fractional curettage
i.history:means the etiologic factors
ii.clinical manifestation:include symptoms
and body signs
iii.fractional curettage
iv.other accessory examination
(i).cytologic examination
(ii).B-ultrasound
(iii).hysteroscopy
(iv).MRI,CT,lymphography and CA-125
VII.Differential diagnosis
i.dysfunctional uterine bleeding in
transitional period of menopause
ii.senile vaginitis
iii.submucous myoma or endometrial
polyp
iv.primary fallopian tube cancer
v.senile endometrial inflammation
complicated with uterine cavity mpyema
vi.cervical canal cancer
VIII,Treatment:the determination of treating
method
i.surgical treatment:the first selected method
(i).stageI:Toral hysterectomy and bilateral adnexectomy,
Indication of pelvic and para-aortic lymphadenectomy
(ii).stageII:Radical hysterectomy and pelvic and para-
aortic lymphadenectomy
ii.operation plus radiotherapy
(i).postoperative radiotherapy:stage I
(ii).preoperative radiotherapy:stage II and III
iii.radiotherapy,for senile patients or with severe
complications which can not stand operation or stage
III,IV cancer which do not fit for the operation
iv.progesterone treatment
(i).indication of progesterone therapy
(ii).mechanism of progesterone therapy
v.antiestrogen drug therapy
vi.chemotherapy:for late stage or recurrent
cancer which do not fit for the operation
IX.Follow up
Follow up should take regularly after
treatment and determine whether there is
recurrence.
Follow up time:within 2 years after
operation,once every 3~6 month;3~5
years after operation,once a time every
6~12 month.
The content of follow up include pelvic
examination,Vaginal cytologic mear,chest
x-ray and CA-125.
X.Prevention
The methods of prevention and early diagnosing
Endometrial cancer includes:
1.popularization of Cancer prevention knowledge
and take cancer Prevention examination regularly.
2.mastering theIndication of using estrogen.
3.the endometrial cancer Should be suspected firstly
in premenopausal women With menstrual
disturbance or irregular vaginal bleeding.
4.there is possibility of endometrial cancer
In postmenopausal women with vaginal bleeding
5.high risk factors and high risk patient should be
paid attention to
INTRODUCTION
Endometrial cancer is one of the three main malignant
tumors,usually occurs between 58~61 years old.
Accounts for about 7% of female malignant tumors,and
20%~30% of female malignant tumors in reproductive
system
I.Etiology:not very clear
i.long term and continuous stimulation of
estrogen on endometrium
ii.over hyperplasia of endometrium
iii.constitutional factors
iv.postponed menopause
v.hereditary factor:20% has family history
II.Pathology
i.macroexamination
(i).diffused type
(i).localized type
ii.microscopic examination
(i).endometrioid adenocarcinoma(80%)
histological grade
G1:nonsquamous solid growth≤5%
G2:nonsquamous solid growth
6%~50%
G3:nonsquamous solid growth＞ 50%
(ii).adenocarcinoma with squamous
differentiation
i).adenoacanthoma
ii).adenosquamous carcinoma
iii).adenocarcinoma with squamous
atypical hyperplasia
(iii),clear cell carcinoma (4%)
(iv),serous adenocarcinoma(10%)
III.Metastatic path
i.directly spreading
ii.lymphetic metastasis
iii.blood metastasis
Metastatic Path
1.Directly spreading:cances focus grow on the endometrium and
to fallopian tube,to cervix and vagina,to myometrium and
serous and fallopian tube and ovary.Finally implant on the
pelvic peritoneum,pouch of Douglas and omentum.
2.Lymphatic metastasis:the chief metastatic path.
(1).uterine fundus cancer uper edge of broad ligament
suspend ligament and ovary and paraarotic LN.
(2).uterine corner cancer,along round ligament inguinal LN
(3).lower segment and cervical canal cancer parauterine,inter-
nal iliac,external iliac and common iliac LN,
(4).posterior wall cancer along uterosacral ligament rectal LN
(5).endometrial cancer can also bladder and vagina.
IV.Clinical stage
For non-operative patient we adopt FIGO(1971)
clinical stage.
For patient who has accepted operation,we adopt
FIGO(1988) operative-pathologic stage.
Clinical stage of endometrial cancer(FIGO 1971)
Stage 0 adenomatoid hyperplasia or carcinoma in
situ
Stage I cancer is located in the uterine cavity
Ia the length of uterine cavity≤8cm
Ib the length of uterine cavity>8cm according
to the histological differentiation,Ia and Ib
is also divided into 3 sub-grades:grade1 means well-
diferentiated adenocarcinoma;grade2 means moderate
differentiation;grade3 means undifferenatiated
carcinoma
Stage II cancer has spreaded to cervix
Stage III cancer spreading is beyond uterus but not
beyond the true pelvis
Stage IV cancer spreading is beyond true pelvis or
involving mucosa of bladder or rectum
IVa cancer spreads to nearby organs,such as
bladder or rectum
IVa cancer has telemetastasis
Operative-pathologic stage of endometrial
carcinoma
(FIGO 1988)
stageIa G123 cancer is located in the endometrium
stageIb G123 there is myometrial invasion and
≤1/2
stageIc G123 the myometrial invasion>1/2
stageIIa G123 cervical gland is involved
stageIIb G123 cervical stroma is involved
stageIIIa G123 cancer invades uterine serosa and (or)
adnex,and(or) abdominal cavity
cytologic examin tion is positive
stageIIIb G123 vaginal is involved
stageIIIc G123 there is pelvic and (or) para-aortic
lymphenodes metastasis
stageIVa G123 the bladder and (or) rectum mucosa
is involved
stageIVb G123 there is telemetastasis which
includes abdominal cavity and (or)
inguinal lymphe nodes metastasis
V.Clinical manifestation
i.symptoms
(i).vaginal bleeding
(ii).vaginal discharge
(iii).pain
(iv).general symptoms
ii.body signs
at early stage→with the further
development → at late stage →if there is
uterine empyema →if there is parauterine
invasion
VI.Diagnosis:apart from the
history,symptoms and body signs,the final
confirmed diagnosis is based upon the
pathologic results of fractional curettage
i.history:means the etiologic factors
ii.clinical manifestation:include symptoms
and body signs
iii.fractional curettage
iv.other accessory examination
(i).cytologic examination
(ii).B-ultrasound
(iii).hysteroscopy
(iv).MRI,CT,lymphography and CA-125
VII.Differential diagnosis
i.dysfunctional uterine bleeding in
transitional period of menopause
ii.senile vaginitis
iii.submucous myoma or endometrial
polyp
iv.primary fallopian tube cancer
v.senile endometrial inflammation
complicated with uterine cavity mpyema
vi.cervical canal cancer
VIII,Treatment:the determination of treating
method
i.surgical treatment:the first selected method
(i).stageI:Toral hysterectomy and bilateral adnexectomy,
Indication of pelvic and para-aortic lymphadenectomy
(ii).stageII:Radical hysterectomy and pelvic and para-
aortic lymphadenectomy
ii.operation plus radiotherapy
(i).postoperative radiotherapy:stage I
(ii).preoperative radiotherapy:stage II and III
iii.radiotherapy,for senile patients or with severe
complications which can not stand operation or stage
III,IV cancer which do not fit for the operation
iv.progesterone treatment
(i).indication of progesterone therapy
(ii).mechanism of progesterone therapy
v.antiestrogen drug therapy
vi.chemotherapy:for late stage or recurrent
cancer which do not fit for the operation
IX.Follow up
Follow up should take regularly after
treatment and determine whether there is
recurrence.
Follow up time:within 2 years after
operation,once every 3~6 month;3~5
years after operation,once a time every
6~12 month.
The content of follow up include pelvic
examination,Vaginal cytologic mear,chest
x-ray and CA-125.
X.Prevention
The methods of prevention and early diagnosing
Endometrial cancer includes:
1.popularization of Cancer prevention knowledge
and take cancer Prevention examination regularly.
2.mastering theIndication of using estrogen.
3.the endometrial cancer Should be suspected firstly
in premenopausal women With menstrual
disturbance or irregular vaginal bleeding.
4.there is possibility of endometrial cancer
In postmenopausal women with vaginal bleeding
5.high risk factors and high risk patient should be
paid attention to
