Endometrium Cancer

Dr.Supanji Raharja, SpOG(K)

Medical Faculty
Muhammadyah University
Surakarta 2018
Endometrium

Inner membrane of
the mammalian uterus.
 Endometrium
 Lining for the uterus
 Preventing adhesions between the
opposed walls of the myometrium.
 Soft and spongy.
 Each month endometrium change as part
of menstrual cycle.
What is Endometrial
Cancer?
Cause

The exact cause is unknown.

Estrogen
Risk Factors
Sex, Age, Family History

Irregular menstrual periods

Early first menstruation or late menopause
Infertility

Obesity
Diabetes
Hypertension

Estrogen replacement therapy and/or Tamoxifen

Women who have been
treated with tamoxifen,
a drug used to prevent and
treat breast cancer, may
have a slightly increased
risk of developing
endometrial cancer.
-to treat the symptoms of menopause.
-help prevent osteoporosis.
-by taking the hormone progestogen
along with estrogen, the risk of
endometrial cancer is reduced
substantially
Diagnosis
HYSTEROSCOPE
-an endoscope is used to guide the endometrial
biopsy or D&C.
-he tube is inserted into the uterus through the
Cervix.
-A hysteroscopy allows the doctor to view the
inside of the uterus while collecting endometrial
tissue samples.
Hysterosco
py
Endometrial stromal sarcoma gross
 Signs and symptoms
• Vaginal bleeding and/or spotting in
postmenopausal women. It may start as a watery,
blood-streaked flow that gradually contains more
blood. After menopause, any vaginal bleeding is
abnormal.
• Abnormal uterine bleeding, abnormal menstrual
periods.
 Bleeding between normal periods in
premenopausal women in women older
than 40: extremely long, heavy, or
frequent episodes of bleeding (may
indicate premalignant changes).
 Anemia, caused by chronic loss of blood.
(This may occur if the woman has ignored
symptoms of prolonged or frequent
abnormal menstrual bleeding.)
 Lower abdominal pain or pelvic cramping.
 Thin white or clear vaginal discharge in
postmenopausal women.
 Weight loss.
TYPE OF ENDOMETRIAL
CANCER
Type 1
caused by excess estrogen

Type 2
experts aren't sure what causes
type 2 cancers, but they don't seem
to be caused by too much estrogen
TYPE I
 not very aggressive

 slow to spread to other tissues

 grades 1 and 2 endometrial cancers are "type 1" endometrial cancer

 occur most commonly in pre- and peri-menopausal women

 history of unopposed estrogen exposure and/or endometrial

hyperplasia

 carry a good prognosis.

TYPE II

 occur in older, post-menopausal women

 more common in African-Americans

 more likely to grow and spread outside

of the uterus

 carry a poorer prognosis

Example of type I cancer

 Endometrial adenocarcinoma
Endometrial adenocarcinoma
 most common type of uterine cancer

 it arises from the glands of the endometrium

 About 80% of uterine cancers are adenocarcinomas, and they have

varying aggressiveness.

 The pathologist assigns a "grade" to this cancer, which basically says

how cancerous it looks under the microscope.

 While "Grade I" looks a lot like normal uterine tissue and can be very
indolent, "Grade III" looks very cancerous and will probably be
aggressive. "Grade II" is intermediate in looks and behavior.

 About 40% of adenocarcinomas are "Grade I," 20% are "Grade II,"
and 40% are "Grade III
Example of type II cancer

 the uterine papillary serous carcinoma

 the uterine clear cell carcinoma

High-grade endometrioid cancer
Uterine papillary serous carcinoma
Uterine papillary serous carcinoma

 uterine papillary serous carcinoma (UPSC) is an uncommon

form of endometrial cancer that typically arises in
postmenopausal women.

 is the worst type since it is very aggressive and tends to come

back even when caught early. It represents 5% of uterine cancers.

 It is typically diagnosed on endometrial biopsy, prompted by post-

menopausal bleeding.

 It arises in the setting of endometrial atrophy and is classified as

a type II endometrial cancer.
uterine clear cell carcinoma
uterine clear cell carcinoma
 Uterine clear cell carcinoma (CC) is a rare form of
endometrial cancer with distinct morphological features on
pathology; it is aggressive and has high recurrence rate.

 is an aggressive cancer accounting for about 2% of

uterine cancers.

 It is associated with a woman's mother having used a

hormone called DES while pregnant, and is getting less
common with DES no longer used.

 Like uterine papillary serous carcinoma CC does not

develop from endometrial hyperplasia and is not hormone
sensitive, rather it arises from an atrophic endometrium.
Treatment for endometrial cancer

 Depends on the stage of the disease and the

overall health of the patient.
 Primary treatment is the surgery (removal of
the tumor ).
 Radiation therapy, hormone therapy, and/or
chemotherapy may be used as adjuvant
treatment (i.e., in addition to surgery) in
patients with metastatic or recurrent disease.
Surgery

 Surgery (removing the tumor in an

operation) for endometrial cancer is
also known as hysterectomy which the
uterus is surgically removed with or
without other organs or tissues.
Total hysterectomy:
Surgery to remove the uterus,
including the cervix

Total hysterectomy with

salpingo-oophorectomy:
unilateral
the uterus and cervix plus one
ovary and fallopian tube are
removed

the uterus and cervix plus both

bilateral
ovaries and fallopian tubes are
removed
 Radical hysterectomy:
The uterus, cervix, both These procedures are
ovaries, both fallopian done using a low
tubes, plus part of the transverse incision or a
vagina, and nearby tissue vertical incision
are removed

Part of
vagina
Chemotherapy
 Treatment that uses drugs to stop the
growth of cancer cells, either by killing the
cells or by stopping the cells from dividing.
 Treatment usually involves a combination
of two or three chemotherapy drugs.
 This treatment may be considered in some
cases, especially for those with stage 3
and 4 disease.
 Chemotherapy also may be used in
addition to surgery (called adjuvant
therapy) to treat metastatic endometrial
cancer and to prevent recurrent
disease.

 Adjuvant chemotherapy for endometrial

cancer is usually given for a total of six
to eight 21-day cycles (the treatment is
given once every 21 days for a total of
six to eight treatments).
 The following drugs are used to treat
endometrial cancer:
 Carboplatin (Paraplatin®)
 Cisplatin (Platinol®)
 Doxorubicin (Doxil®)
 Cyclophosphamide (Cytoxin®)
 Paclitaxel (Taxol®, Paxene®)
RADIATION THERAPY
 Compared with low-risk endometrial cancer, intermediate-risk
cancers have a higher chance of coming back after surgery.
 Intermediate-risk endometrial
–cancer has invaded more deeply into the lining of the
uterus, or
–evidence of cancer invasion into the cervix when the
hysterectomy specimen is examined under a microscope.
 Radiation therapy is recommended for some women after
surgery. This practice is called "adjuvant" radiation therapy.
–The purpose is to get rid of any tumor cells that might be
left in the body after surgery.
Adjuvant radiation therapy (RT)
Vaginal brachytherapy
 Low-dose rate brachytherapy
uses a device that delivers
radiation through the vagina
continuously for two or three
days, 24 hours per day.
 High-dose rate brachytherapy
uses a device that delivers
radiation in the vagina for only
a few minutes at a time once a
day, and treatment is generally
repeated three to five times.
This treatment is generally
given as an outpatient and do
not have to stay in the hospital
overnight.
External beam RT
 During EBRT, your body is
positioned beneath the X-ray
machine in the same way every
day, and the radiation field is
exposed to the radiation beam for
a few seconds once per day, five
days per week, for five to six
weeks.
 The choice between external
beam RT and vaginal
brachytherapy depends on a
number of factors. However, for
most women with intermediate-
risk disease, vaginal
brachytherapy seems to be as
effective as external beam RT.
Hormone therapy

 Hormone therapy is a cancer treatment that

removes hormones or blocks their action and stops
cancer cells from growing.
 Hormones are substances made by glands in the
body and circulated in the bloodstream.
 Some hormones can cause certain cancers to grow.
 If tests show that the cancer cells have places
where hormones can attach (receptors), drugs,
surgery, or radiation therapy is used to reduce the
production of hormones or block them from working.
 Progestins
 The main hormone treatment for endometrial cancer
 Eg - medroxyprogesterone acetate (Provera ®) and megestrol
acetate (Megace®).
 Slowing the growth of endometrial cancer cells. Side effects
can include increased blood sugar levels in patients with
diabetes.

 Tamoxifen
 An anti-estrogen drug often used to treat breast cancer, may
also be used to treat advanced or recurrent endometrial cancer.
 Prevent any estrogens circulating in the woman's body from
stimulating growth of the cancer cells and nourishing the
cancer cells.
 It does not cause bone loss, but can cause hot flashes, vaginal
dryness and increased risk of serious blood clots in the leg.
 Gonadotropin-releasing hormone agonists
 These drugs switch off estrogen production by the ovaries in women who are
premenopausal.
 Eg- goserelin (Zoladex) and leuprolide (Lupron). These drugs are injected every 1 to
3 months.
 Side effects can include hot flashes and vaginal dryness. If they are taken for a long
time (years), these drugs can weaken bones (leading to osteoporosis).

 Aromatase inhibitors
 After the ovaries are removed estrogen is still made in fat tissue.
 Stop this estrogen from being formed and lower estrogen levels even further.
 Eg - letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin).
 These drugs are most often used to treat breast cancer, but may be helpful in the
treatment of endometrial cancer.
 Side effects can include joint and muscle pain and hot flashes. If they are taken for a
long time (years), these drugs can weaken bones (leading to osteoporosis).
 These drugs are still being studied for use in treating endometrial cancer
Refferance

 http://www.emedicinehealth.com/endom
etrial_cancer/page2_em.htm
.
 http://www.medicinenet.com/uterine_can
cer/article.htm
.
The End