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Endometrial Cancer

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Endometrial Cancer Steven Elg MD, PhD * * * * * * * * * * * Ovarian Cancer: Stage Distribution and Survival American Cancer Society 2006 Endometrial Cancer 7,000 ... – PowerPoint PPT presentation

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Title: Endometrial Cancer


1
Endometrial Cancer Steven Elg MD, PhD
2
Ovarian Cancer Stage Distribution and Survival
Endometrial Cancer
Year Cases Deaths
1987 35,000 2,900
2000 36,100 6,500
2006 41,200 7,000
  • American Cancer Society 2006

3
Endometrial Cancer
  • Type I
  • Estrogen Related
  • Younger and heavier patients
  • Low grade
  • Exogenous estrogen
  • Type II
  • Aggressive
  • Unrelated to estrogen stimulation
  • Occurs in older thinner women
  • Potential genetic basis
  • Lynch syndrome
  • Familial trend

4
Ovarian Cancer Stage Distribution and Survival
Endomerial Cancer
Characteristic Relative Risk
Obesity
gt30 LBS gt50 LBS 3 10
Nulliparous 2
Late Menopause 4
Unopposed Estrogen 9.5
Atypical Hyperplasia 29
Diabetes 2.8
Hypertension 1.5
  • American Cancer Society 2000

5
Endometrial Cancer Screening
  • Patient Primary
  • Cytology Not satisfactory
  • Histology Secondary
  • Hysteroscopy Not satisfactory
  • Sonography Cost effective issue

6
Endometrial Cancer Who Needs an Endometrial
Biopsy?
  • Postmenopausal bleeding
  • Postmenopausal women with endometrial cells on
    Pap
  • Perimenopausal intermenstrual bleeding
  • Abnormal bleeding with history of anovulation
  • Thickened endometrial stripe via sonography

7
Endometrial Cancer Transvaginal Ultrasound
Screening
N250 N250 N250 N250 N250
Endometrial Stripe Thickness Endometrial Stripe Thickness Endometrial Stripe Thickness Endometrial Stripe Thickness
Diagnosis lt5mm 6-10mm 11-15mm gt15mm
Atrophy 93 7
Hyperplasia 58 42
Polyp 53 47
Cancer 18 41 41
Grigoriou Maturitus 239-14, 1996 Grigoriou Maturitus 239-14, 1996 Grigoriou Maturitus 239-14, 1996 Grigoriou Maturitus 239-14, 1996 Grigoriou Maturitus 239-14, 1996
8
Endometrial Cancer Survival by Clinical Stage
Stage Survival ()
I 70.2 76.3
II 17.8 59.2
III 8.1 29.4
IV 3.6 10.3
Modified FIGO 1991 Modified FIGO 1991 Modified FIGO 1991
9
Endometrial Cancer FIGO Surgical Stage
Stage I Confined to uterus
Stage II Cervix involved
Stage III Uterine serosa, adnexae, vaginal metastasis, pelvic/aortic node metastasis
Stage IV Bladder, bowel, inguinal node, distant metastasis
10
Endometrial Cancer Poor Prognosis Factors
  • Increasing age (over 65)
  • Stage
  • Vascular invasion
  • Grade
  • Histologic subtypes (Clear cell, Serous)
  • Aneuploidy
  • Cytokinetics
  • Altered oncogene/tumor suppressor gene expression

11
Endometrial Cancer Nodal Involvement
Situation Positive Nodes
G1, no myometrial invasion, no extrauterine disease. lt1
G2 or G3, inner 1/3 invasion, no extrauterine disease. 5-9 Pelvic 4 Aortic
G3, outer muscle, and/or extrauterine disease 20-60 Pelvic 10-30 Aortic
12
Endometrial Cancer Pre-op Evaluation
  • CA 125
  • Chest X-ray
  • Mammograms
  • Colon Evaluation
  • Transvaginal Ultrasound
  • Others

13
Endometrial Cancer Intra-operative principals
  • Availability of frozen section
  • Capability of complete surgical staging
  • Capability of tumor reduction if indicated

14
Endometrial Cancer Surgical Staging
  • Conceptual rationale
  • Defines extent of disease
  • Minimizes over/under treatment
  • Minimally increases perioperative morbidity,
    mortality
  • Decreases overall Rx risks and costs
  • Allows comparison of therapeutic results

15
Endometrial Cancer Surgical Approach
  • Complete hysterectomy, BSO/washings only
  • Grades 1,2
  • lt50 myometrial invasion
  • Endometroid
  • lt 2cm tumor diameter

16
Endometrial Cancer Surgical Approach
  • Complete surgical staging
  • Grades 3
  • gt50 myometrial invasion
  • Serous/clear cell
  • Advanced stages

17
Endometrial Cancer Adjuvant Therapy
  • Brachytherapy
  • External beam radiotherapy
  • Hormonal therapy
  • Cytotoxic chemotherapy
  • Combination therapy

18
Endometrial Cancer Determinants of Adjuvant
Therapy
  • Stage
  • Histologic subtypes
  • Staging completeness
  • Tumor biology
  • Medical conditions

19
Endometrial Cancer Follow up
  • Pelvic examination
  • Pap smears
  • CA 125 high risk
  • Chest X-ray high risk

20
Endometrial Cancer Recurrence
  • 80 of recurrences happen first three years
  • Most will be symptomatic
  • Rare to cure distant recurrences
  • 50 vaginal recurrences cured

21
Endometrial Cancer Recurrence
Site
Distant 65
Pelvic and distant 15
Pelvis only 15
vagina 6
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