en dome trial carcinoma

7/31/2019 En Dome Trial Carcinoma

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Endometrial Carcinoma


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Introduction

The most common malignant disease affecting

the uterus

No effective screening procedure for early

detection

Significant morbidity in the community due to

surgery and radiotherapy


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Epidemiology

Vats majority occur in over 45 yrs of age

Incidence rises steeply from 45-55 yrs old

Affects approx. 1 in 69 women before the ageof 75

370 deaths from the disease each year


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Risk factors

Obesity

Impaired carbohydrate tolerance

Nulliparity

Late menopause

Unopposed oestrogen therapy

Functioning ovarian tumours

Previous pelvic irradiation

Family history of carcinoma of breast, ovary or colon History of chronic anovulation

Poilycystic Ovarian syndrome associated with chronicanovulation


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Aetiology

Increase in oestrogen levels obesity aromatisation

Postmenopausal diabetes

Reduced risk in: OCP, progestogen usage

Cigarette smoking

Proposed mechanism: interaction betweenoestrogen, insulin and IGF-1


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Pathology

Endometrioid carcinoma Commonest type

Resembles the normal proliferative endometrium butarchitecture is much more complicated

Squamous metaplasia can occur in this adenocarcinoma Papillary serous

Aggressive form

Clear cell carcinoma

Aggressive form Primary squamous cell carcinoma

Extremely rare


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Clinical presentation

Postmenopausal bleeding

Postmenopausal discharge

Intermenstrual bleeding 1/3 only heavy bleeding


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DiagnosisHistory:

Menses history, nature of the current bleeding problems, the patients qualityof life with respect to the current problem and any associated symptoms.

Heavy bleeding, irregular bleeding patterns (>80ml) need investigation

Investigations:

Pelvic examination

Speculum examination of cervix, vagina and vulva

Blood tests: FBC, TFT, coagulation studies

Transvaginal ultrasound (screening tool performed in the first half of themenstrual cycle for endometrial thickness) If > 5mm for perimenopausal and >12mm for postmenopausal

Endometrial Biopsy

Diagnostic hysteroscopy. If endometrial biopsy is performed with ahysterocopy more accurate samples are likely to be obtained

Dilatation and Curettage with concurrent hysteroscopy


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Perimenopausal women


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Postmenopausal women


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Staging

FIGO staging of carcinoma of the corpus uteri

Stage DescriptionI The carcinoma is confined to the corpus

II The carcinoma is confined to the corpus and the cervix hasnot extended outside the uterus

III the carcinoma has extended outside the uterus but not

outside the true pelvis

IV The carcinoma has extended outside the true pelvis or has

obviously involved the mucosa of the bladder or rectum


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Treatment

Surgery

Total abdominal hysterectomy and bilateral salpingo-oophorectomy

Radical hysterectomy with bilateral pelvic lymphadenectomywith paraaortic node sampling is only performed if the

cervical spread is clearly recognised before surgery (oftenstill wiser to treat with radiotherapy)

Radiotherapy With more advanced disease

Initial radiotherapy

Residual disease removed surgically

Progestogens Palliation of recurrent disease

Well differentiated tumours with oestrogen receptors


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Prognosis

5 year survival for women with endometrial

cancer

Stage 5 year survival %

Stage I 83

Stage II 71

Stage III 39Stage IV 27

en dome trial carcinoma

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