Endometrial Carcinoma

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Endometrial Carcinoma

• Shabina Nazir
• MS 113
• 10/7/04

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Endometrium

• Inner mucosal layer of the uterus
• Composed of two layers
• Zona Functionalis (inner layer) part of the
  endometrium that develops and is sloughed each
  month
• Zona Basalis (outer layer)

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Endometrium
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Endometrium
Zona functionalis
Zona basalis
Myometrium
Endometrium
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zona Functionalis

• This tissue, obtained near the end of the
  menstrual phase, demonstrates sloughing of the
  zona functionalis (a)

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Normal Thickness

• Increases in size from 2-16mm depending on the
  phase of the menstrual cycle
• Use of unopposed estrogen causes increase in
  thickness
• Typically
• Menstruating female 4 - 12mm
• Post-menopausal female 4 10mm

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Normal Proliferative Endometrium
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Normal Secretory Endometrium
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COR Uterus (3D Reconstruction)Normal Endometrium
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Patient Profile

• 74 year old female
• Gravida 2, Para 2
• Pelvic pain
• Post-menopausal bleeding

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Medical History

• Breast cancer a year ago
• Use of tamoxifen
• Family history of polycystic ovarian disease
• Patients mother
• Transvaginal ultrasound ordered

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Medical Findings

• Ultrasound shows an enlarged mass of mixed
  echogenicity within the endometrial cavity
• Doppler flow within the mass shows low resistive
  index

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Sag TV US image of the uterus shows a central
mass replacing the endometrial stripe
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TRV TV US image of the uterus shows a central
mass replacing the endometrium
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Endometrial Carcinoma
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Medical Findings

• TV followed by endometrial biopsy
• Endometrial Biopsy - positive

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Diagnosis

• Endometrial Carcinoma

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Endometrial Carcinoma

• Cancer of the endometrium
• Most common GYN malignancy
• Fourth most common malignancy in women in USA

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Population Most Affected

• Post-menopausal women
• More common in white
• Jewish women more at risk

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Etiology

• Estrogenic stimulation
• Dysfunctional uterine bleeding
• Polycystic ovaries

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Symptoms

• Post-menopausal vaginal bleeding
• Occasional spotting
• Hypermenorrhea
• Hyperestrogenism
• Pelvic pain

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Sonographic Appearance

• Thickened endometrial lining, with heterogenous
  echo pattern
• Uterus may be enlarged and lobular
• Endometrial canal may be deviated

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Sonographic Appearance
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Endometrial Carcinoma
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Endometrial CA
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Endometrial CA
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CT
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Risk Factors

• Obesity
• Hypertension
• Diabetes
• Nulliparity
• Unopposed estrogen use
• Strong family history
• Late menopause

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Differential Diagnosis

• Fibroids
• Endometrial Hyperplasia
• Endometrial polyp
• Endometrial sarcoma

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Prognosis and Treatment

• Stage and grade are determinants of prognosis and
  treatment
• grade - histologic differentiation
• Grade I- well differentiated- identifiable glands
• Grade II- Moderately differentiated- sheets of
  cells, still see some glands
• Grade III- Atypical- sheets of cells, no glands

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Prognosis and Treatment

• Stage - location of the tumor
• If disease is confined to the body of the uterus
  and no cervical involvement (stage1)
• Laparotomy
• Hysterectomy
• If cervix is involved (stage 2)
• Pre-hysterectomy pelvic radiotherapy

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Prognosis and Treatment

• When found and treated early, the cure rate is
  better than 90
• Optimal treatment for individuals with recurrent
  endometrial carcinoma yet to be determined

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References

• http//www.obgyn.net/us/gallery/Gyn_Normal_Prolife
  rative_Endometrium.jpg
• http//www.obgyn.net/us/gallery/Gyn_Normal_3D_Uter
  us_Coronal.jpg
• http//www.emedicine.com/radio/topic253.htmtarget
  1
• http//www.bccancer.bc.ca/HPI/CancerManagementGuid
  elines/Gynecology/Endometrium/Diagnosis.htm
• http//www.cancernetwork.com/journals/oncology/o99
  12b.htm
• http//www.anatomy.wright.edu/ant201202/ant202/fem
  ale/labelfemale/labelfemale12.html
• http//www.hsc.missouri.edu/md2003/update8/4-25ca
  se.doc
• http//www.up.ac.za/academic/medicine/telemed/Hist
  /088/088me01.html
• www.aafp.org/afp/990600ap/3069.html
• Hall, Rebecca. The Ultrasound Handbook. 3rd ed.
  Philadelphia Lippincott, 1999.
• OB/Gyn Ultrasound. Uterus II handout.