2. A significant increase in the incidence of endometrial cancer. This increased incidence of endometrial cancer has been widely interpreted to be a result of the marked increase in exogenous estrogen use

3.  Ovarian: commonest 50-69 years  Cervix: 15-34 years & >50 yrs  Endometrium: >45 yers.. Majority >60 yrs of age

4. Risk Indicators for Endometrial Cancer and Precursors  Age 60 years  Obesity (with upper body fat pattern) a  Estrogen-only replacement therapy  Previous breast cancer  Tamoxifen therapy for breast cancer  Chronic liver disease  Infertility  Low parity  Chronic anovulation (Polycystic ovarian disease, estrogen- secreting ovarian stroma or tumors)

5. Risk Factor Approximate Risk Ratios Obesity1.8–2.4 Nulliparity2.0–3.0 Diabetes mellitus2.8 Prior irradiation8.0 Granulosa-theca cell tumors5.0 Exogenous estrogen therapy3.0–8.0 Late menopause (>age 52)2.4 Summary of Probable Risk Factors Associated with Endometrial Cancer

6. Endometrial hyperplasia

7. WHO Classification and Diagnostic Criteria of Endometrial Hyperplasia Simple Hyperplasia Without Cytologic Atypia Increased number of glands relative to stroma Dilated glands with irregular outlines Crowded, clustered glands Tall, columnar epithelium with nuclear pseudostratification Complex Hyperplasia Without Cytologic Atypia Increased number of glands relative to stroma Back-to-back glands (crowded glands with little or no intervening stroma) Hyperplasia With Cytologic Atypia Variation of size and shape of nuclei Nuclear enlargement Loss of polarity Coarse chromatin clumping Prominent nucleoli Hyperchromatism

8. Endometrial hyperplasia Cystic hyperplasiaSimple hyperplasia

9. Atypical hyperplasia Simple hyperplasia

10. Based on the incidence of endometrial carcinoma in asymptomatic women, it would take about 1000 procedures to detect a single case of either a carcinoma or its precursor No controlled randomized trials have been done to evaluate the effectiveness of prevention of screening in endometrial carcinoma. Even in high-risk menopausal women, screening would detect only 50% of all cases of endometrial carcinoma

11. Corpus cancer

12. Histopathologic Subtypes of Endometrial Carcinoma *Endometrioid adenocarcinoma Villoglandular (papillary) Secretory Ciliated cell Adenocarcinoma with squamous differentiation *Mucinous carcinoma *Serous carcinoma *Clear cell carcinoma *Squamous cell carcinoma *Undifferentiated carcinoma *Mixed carcinoma *Metastatic carcinoma

13. According to the U.S. Gynecologic Oncology Group histologic grading system, 1 1 grade 1, well-differentiated carcinoma, consists of a neoplasm with less than 5% of solid cancer grade 2, moderately differentiated carcinoma, contains between 6% and 50% solid cancer grade 3, poorly differentiated carcinoma, is made up of more than 50% of solid tumor.

15.  Irregular vaginal bleeding,,,, intermenstrual or post menopausal  Watery vaginal discharge may be present in postmenopausal women  Mass in late stages

16.  T.V.S. and biopsy  Hysteroscopy and biopsy  ? M.R.I. Or C.T. scan

17.  Hysteroscopy and biopsy

18.  T.V.S. and biopsy

19.  Operative: total abdominal hysterectomy and Bilateral Salpengo-oophorectomy +/_ lymph node dissection is the operation of choice.  Adjuvant Radiotherapy for >1b  Chemotherapy ineffective  Hormonal therapy, progestogens, in early or recurrent cases

20.  5-year survival rate is:  Stage I: 80-85% {grade 1 90%; grade 3 65%}  Stage II: 55-60%  Stage III: 35-40%  Stage IV: <10%