Endometrium Cancer

 Cancer of uterine endometrial lining

 Most common female genital cancer
 Adenocarcinoma is the most common type
 Metastatic routes : Uterus, uterine tubes, ovaries
 Lymphogenous

 Hematogenous

 Intraperitoenal
 Risk Factors
 Obesity
 Excessive adipose tissue → Increase peripheral estrone

production → Negative feedback to HPA → Oligo or

anovulation → Endometrium is exposed to estrogen
continuously without progesterone
 Unopposed estrogen
 Exogenous : Estrogen replacement therapy

 Endogenous : Granulosa cell tumor, PCOS

 High dietary animal fat

 Early age of menarche and late menopause
 Treatment with tamoxifen for breast cancer
 Diabetes mellitus, hypertension
 History or breast or ovarian cancer, family history
 Prior radiation therapy for pelvic cancer
 Older than 35 years old
 Infertility or nulliparous
 Anovulatory cycles
 Reduced risk : Combined oral contraceptive, smoking
 Smoking ??
 Reduce the risk because
 Reduced levels of estrogen through weight reduction
 Earlier age at menopause
 Altered hormonal metabolism
 Although it is reduces the risk, this advantage is strongly
outweighed by increased risk of lung cancer
 Signs and Symptoms
 Non-menstrual bleeding or discharge
 Especially post menopause bleeding

 Heavy bleeding, metroharrgia, postcoital bleeding

 Dyspareunia, pelvic pain and or mass
 Weight loss
 Back pain
 Lower extremity edema
 Diagnosis
 Pelvic examination : May be entirely normal
 Vaginal ultrasonography as the first choice
 Detect endometrial thickness (> 4 mm)

 Endometrial biopsy : Provide the histopathology result

 Dilatation and curettage
 Obtaining scrapings from endometrium and cervix

 Detect the spread of malignancy

 Pap smear to detect the spread to cervix

 Hysteroscopy to visualize whole uterine cavity
 Endometrial Hyperplasia
 Overgrowth of the glandular epithelium of endometrial lining
 Usually occurs when a patient is exposed to unopposed
estrogen, either estrogenically or because of anovulation
 Rates of neoplasm
 Simple hyperplasia : 1%

 Complex hyperplasia with atypia : 30%

 Treatment
 Surgery
 Hysterectomy, salpingo-oophorectomy

 Pelvic lymph node dissection

 Laparoscopic lymph node sampling

 Radiation therapy : Brachitherapy

 Chemotherapy
 Hormone therapy
 Progesterone

 Tamoxifen increase progesterone receptors

Abnormal Uterine
Bleeding
 Disturbance in frequency,
duration, or amount of
menstrual blood loss
 Major differential diagnosis
 Rule out pregnancy

 Children : Sexual abuse

 Post menopause :

Endometrium carcinoma
 The Terms
 Menorrhargia : Excessive blood loss at regular intervals
 Polymenorrhea : Regular bleeding at intervals < 21 days
 Oligomenorrhea : Infrequent menstruation at intervals greater
than every 35 days
 Amenorrhea : No uterine bleeding for at least 6 months
 Intermenstrual bleeding : Episodes of uterine bleeding of
varying amount occurring between regular period
 Metroharrgia : Irregular, frequent uterine bleeding (not
excessive) at irregular intervals