Endometrial Cancer

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Pathology 4 Microscopic-pathology 5 Genetics 6 Clinical-manifestations 7 Laboratory 8 Radiology 9 Staging 10 Complications 11 Management 12 More General Terms 13 Additional Terms 14 Internet Database 15 References

Etiology

• risk factors:

• menopause
• infertility or anovulatory cycles
• obesity
• late menopause
• estrogen unopposed by progesterone (see Million Women Study)
• tamoxifen
• family history of cancer: endometrium, breast, or GI tract

• protective factors:

• high progesterone levels of pregnancy
• use of oral contraceptive &/or hormone-replacement therapy containing both estrogen & progesterone

Epidemiology

• most common gynecologic cancer
• peak incidence if in 6th & 7th decades of life

Pathology

• endometrial hyperplasia progresses to endometrial cancer in 10-30% of patients

Microscopic-pathology

• histopathologic types
• endometrioid carcinoma
• villoglandular adenocarcinoma
• adenocarcinoma with benign squamous elements, squamous metaplasia, or squamous differentiation (adenoacanthoma)
• adenosquamous carcinoma (mixed adenocarcinoma and squamous carcinoma)
• mucinous adenocarcinoma
• serous adenocarcinoma ( papillary serous)
• clear cell adenocarcinoma
• squamous cell carcinoma
• undifferentiated carcinoma
• malignant mixed mesodermal tumors

Genetics

• susceptibility associated with defects in MSH2, MSH3, MSH6, MLH1
• other implicated genes ANLN, KIAA1324, PELP1, CASC2, VTCN1, CDH1, PTEN

Clinical-manifestations

• abnormal uterine bleeding

• irregular vaginal bleeding in women > 40 years of age
• postmenopausal bleeding

• vaginal discharge

Laboratory

• PCR/ southern blot/ in-situ hybridization Special labaratory:
• hysteroscopy with endometrial biopsy

Radiology

• transvaginal ultrasound

• thickened, nodular or irregular endometrium ( endometrial stripe)
• fluid in the endometrial cavity
• screening for endometrial cancer not been shown to be cost-effective [5]

• imaging is NOT more effective than physical exam for diagnosing recurrent cancer [2]

Staging

• AJCC/TNM/FIGO

* TNM   FIGO 
* TX         primary tumor cannot be assessed 
* T0         no evidence of primary tumor 
* Tis  0     carcinoma in situ 
* T1   I     tumor confined to corpus uteri 
* T1a  IA    tumor limited to endometrium 
* T1b  IB    tumor invades less than 1/2 of myometrium 
* T1c  IC    tumor invades 1/2 or more of myometrium 
* T2   II    tumor invades cervix , does not extend beyond uterus 
* T2a  IIA   tumor limited to glandular epithelium of endocervix. no evidence of connective tissue stromal invasion. 
* T2b  IIB   invasion of stromal connective tissue of cervix 
* T3   III   local &/or regional spread 
* T3a  IIIA  tumor involves serosa &/or adnexa (direct extension or    
*            metastasis) &/or cancer cells in ascites or peritoneal  
*            washings 
* T3b  IIIB  vaginal involvement (direct extension or metastasis) 
* T4   IVA   tumor invades bladder mucosa &/or bowel mucosa 
* NX         regional lymph nodes cannot be assessed 
* N0         no regional lymph node metastasis 
* N1   IIIC  regional lymph node metastasis to pelvic &/or para- aortic nodes 
* MX         distal metastases cannot be assessed 
* M0         no distant metastasis 
* M1   IVB   distant metastasis (includes abdominal lymph nodes  
*            other than para-aortic &/or inguinal lymph nodes;  
*            excludes metastasis to vagina, pelvic serosa or  
*            adnexa) 
* stage 0      Tis    N0    M0 
* stage I      T1     N0    M0 
* stage IA     T1a    N0    M0 
* stage IB     T1b    N0    M0 
* stage IC     T1c    N0    M0  
* stage II     T2     N0    M0 
* stage IIA    T2a    N0    M0 
* stage IIB    T2b    N0    M0 
* stage III    T3     N0    M0 
* stage IIIA   T3a    N0    M0 
* stage IIIB   T3b    N0    M0 
* stage IIIC   T1     N1    M0 
*              T2     N1    M0 
*              T3     N1    M0 
* stage IVA    T4     N_    M0 
* stage IVB    T_     N_    M1 
* Histologic grading: 
* GX    grade cannot be assessed 
* G1    well differentiated 
* G2    moderately differentiated 
* G3-4  poorly differentiated or undifferentiated 
* G1: 5% or less of a non-squamous or non-morular solid growth  
*     pattern 
* G2: 6% - 50% of a non-squamous or non-morular solid growth  
*     pattern 
* G3: more than 50% of non-squamous or non-morular solid growth  
*     pattern

• notable nuclear atypia inappropriate for architectural grade raises grade to 3
• serous, clear cell and mixed mesodermal tumors are high risk and considered grade 3
• adenocarcinomas with benign squamous elements are graded according to the nuclear grade of the glandular component.
• stage 1: confined to corpus
• stage 2: involves corpus & cervix
• stage 3: extends outside the uterus, but not outside the pelvis
• stage 4: extends outside the pelvis or involves the bladder or rectum

Complications

• 
  
• disease interaction(s) of cancer with Alzheimer's disease

Management

• surgical resection

• total abdominal hysterectomy with bilateral salpingo- oophorectomy
• staging also requires surgery

• radiation therapy in high-risk surgical patients
• chemotherapy is not very effective

• cisplatin
• carboplatin
• doxorubicin
• epirubicin
• paclitaxel

• prognosis

• 5 year survival by stage at presentation

• stage 1: 89%
• stage 2: 80%
• stage 3: 30%
• stage 4: 9%

• storing of embryos prior to therapy is an option in women of of reproductive age
• screening:

• not recommended, does not reduce mortality [2]
• atypical endometrial cells reported on Pap Smear should be further evaluated

More General Terms

• uterine cancer
• carcinoma

Additional Terms

• Breast Cancer Detection Demonstration Project
• Million Women Study
• PCR/southern blot/in-situ hybridization for endometrial cancer

Internet Database

OMIM: 608089

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 29-30
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 607-608
4. AJCC Cancer Staging Manual 6th ed. Springer 2002
5. Jacobs I et al Sensitivity of transvaginal ultrasound screening for endometrial cancer in postmenopausal women: a case-control study within the UKCTOCS cohort Lancet Oncol. 2011 Jan;12(1):38-48. Epub 2010 Dec 10. <PubMed> PMID: [1] <Internet> [2]
   - Vergote I et al Should we screen for endometrial cancer? The Lancet Oncology, Early Online Publication, 13 December 2010 Lancet Oncol. 2011 Jan;12(1):4-5. Epub 2010 Dec 10. No abstract available. <PubMed> PMID: [3] <Internet> [4]
6. Endometrial Cancer (PDQ): Prevention [5]
   - Endometrial Cancer (PDQ): Screening [6]
   - Endometrial Cancer (PDQ): Treatment [7]
7. National Guideline Clearinghouse
   - Pretreatment evaluation and follow-up of endometrial cancer of the uterus. (American College of Radiology) ngc-guideline: [8]
   - Follow-up after primary therapy for endometrial cancer: a clinical practice guideline. (Program in Evidence-based Care) ngc-guideline: [9]
   - Adjuvant radiotherapy in women with stage I endometrial cancer: a clinical practice guideline. (Program in Evidence-based Care) ngc-guideline: [10]
   - Management of endometrial cancer. American College of Obstetricians and Gynecologists ngc-guideline: [11]

endometrial cancer (carcinoma)