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District 1 ACOG Medical Student Teaching Module 2009

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1 District 1 ACOG Medical Student Teaching Module 2009
Endometrial Cancer District 1 ACOG Medical Student Teaching Module 2009

2 Symptoms Post menopausal bleeding Endometrial cells on Pap
Perimenopausal with irregular heavy menses, increasingly heavy menses Premenopausal with abnormal uterine bleeding with history of anovulation

3 Differential Diagnosis for PMB
Exogenous estrogen use- ie tamoxifen Atrophic endometritis/vaginitis Endometrial/cervical polyps Endometrial hyperplasia Endometrial Cancer Other gynecologic cancers

4 Risk factors for Endometrial Cancer
Increased estrogen Hormone therapy Obesity Anovulation/PCOS Estrogen secreting tumors Older age Infertility Early menarche Late menopause Genetics HNPCC Caucasian

5 Preoperative Work-up Endometrial biopsy Ultrasound
For suspected advanced stage may need: Cystoscopy Sigmoidoscopy Pelvic and Abdominal CT Labs CBC Chem 7 Liver function tests EKG, CXR

6 Endometrial Hyperplasia (EIN)
Precursor to endometrial cancer Risk of progression related to cytologic atypia Presents with abnormal bleeding Simple Benign irregular dilated glands No atypia: 1% progress Atypia: 8% progress Complex Proliferation of glands with irregular outlines, back to back crowding of glands, but no atypia No atypia: 3% progress Atypia: 29% progress

7 Staging of Endometrial Cancer
I: Confined to uterine corpus IA: limited to endometrium IB: invades less than ½ of myometrium IC: invades more than ½ of myometrium

8 Staging of Endometrial Cancer
II: invades cervix but not beyond uterus IIA: endocervical gland involvement only IIB: cervical stroma involvement

9 Staging of Endometrial Cancer
III: local and/or regional spread IIIA: invades serosa/adnexa, or positive cytology IIIB: vaginal metastasis IIIC: metastasis to pelvic or para-aortic lymph nodes

10 Staging of Endometrial Cancer
IVA: invades bladder/bowel mucosa IVB: distant metastasis

11 Five Year Survival Stage I: 81-91% Stage II: 71-78% Stage III: 52-60%
72% diagnosed at this stage Stage II: 71-78% Stage III: 52-60% Stage IV: 14-17% 3% diagnosed at this stage

12 Spread Patterns Direct extension Transtubal Lymphatic Hematogenous
most common Transtubal Lymphatic Pelvic usually first, then para-aortic Hematogenous Lung most common Liver, brain, bone

13 Treatment Stage IB or less: total hyst/BSO/PPALND, cytology
Stage IC to IIB: total hyst/BSO/PPALND, cytology, adjuvant pelvic XRT Stage III: total hyst/BSO/PPALND, cytology, adjuvant chemotherapy Stage IV: palliative XRT and chemotherapy

14 Histologic Types Estrogen dependent
Endometrioid- most common Non estrogen dependent- worse prognosis Papillary Serous Clear cell Adenosquamous Undifferentiated

15 Other Types of Uterine Cancer
Leiomyosarcoma Rapidly growing fibroid should be evaluated Stromal sarcoma Carcinosarcoma (MMMT) MMMT leiomyosarcoma

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