1. Endometrial Carcinoma
Women’s Hospital, School of Medicine, Zhejiang university

2. General Considerations
Endometrial carcinoma is one of the most three common pelvic genital cancer in women.
It is malignant epithelioid tumor.
The incidence of endometrial cancer has now raised.
The peak incidence of onset is in the age years.

3. Etiology Etiology of endometrial carcinoma may involve two mechanisms
estrogen-dependent
estrogen-independentcertain

4. Pathology Endometrioid adenocarcinoma Serous adenocarcinoma
Clear cell carcinomas
Mucus adenocarcinoma
Others

5. METASTASIS Direct invasion Lymphatic metastasis
Vascular metastasis(advanced stage)

6. SYMPTOMS
mostly of the disease occurs in the elder patients,there is no symptoms at the very early stage and it is only discovered by examine.
abnormal vaginal bleeding
vaginal fluiding
pelvic pain
weakness, weight loss, and anemia

7. SIGNS
Physical examination is usually unremarkable at the very early stage
The uterus may be enlarged and the mass may move out of the cavity in the advanced cases
Some signs of metastasis can be found of the late stages of the disease

8. Diagnosis History：clinical representation and high risk
factor, family history
vaginal bleeding
High-risk factors
Long term use of E2,TAM
Family history of breast cancer and endometrial carcinomas
Signs

9. Special Examinations Fractional curettage Endometrial biopsy
Endocervical curettage
Diagnose of endometrial carcinoma needs the pathologic results

10. Special Examinations
Endometrial cytology exam are also used in some patients
Ultrasonography can be helpful in deciding clinical staging, In postmenopausal women, 4mm is the cut off for a normal unilateral endometrial stripe
The function of cavityscopy is controversy
MRI and CT appear to improve the accuracy of clinical staging and is particularly helpful in identifying myometrial invasion
Serum CA-125, a well-established tumor marker can also be useful for endometrial cancer

11. Differentiation Dysfunctional uterine bleeding in the menopause women
Senile vaginitis
Endometrial polypus
Pelvic genital cancer in women
Endometritis in elders

12. CLINICAL STAGE According to anatomic sites Stage I： endometrium
Stage II： cervix
Stage III: parametrial，within pelvis
Stage IV：beyond metastasis

13. Staging Clinical staging(FIGO1971)
According to the Fractional curettage and clinical examination
Pre-operation staging
Used in the patients who treat Radiation as primary therapy
Surgical-pathological staging (FIGO2009)
the last staging for the patients who choose surgery as the principal therapy
It is the last staging for the majority

14. Staging

15. THERAPY
Treatment plan for endometrial carcinoma depends on it’s clinical staging and common condition
Surgery , radiation therapy and drugs are all in use
Primary surgery with concomitant therapy is the main treatment in the early stage patients
While in the late stages of the disease include radiation, surgery and drugs therapy.

16. THERAPY Surgical treatment :
Primary treatment, especially in the early stages
Purpose
Definitude the staging and prognostic factors
Excise the lesion

17. SURGICAL TREATMENT Clinical stage Ⅰ
Simple hysterectomy and bilateral salpingo-oophorectomy has been recommended
Make sure to obtain peritoneal washings for cytologic identification of occult spread
The uterus should be opened in the operating room to determine the need for lymphadenectomy

18. SURGICAL TREATMENT The need for lymphadenectomy
Special pathological type
Greater than 50% myometrial invasion
Low differentiation（G3）
> 50％ cavity be involved by the lesion
Cervical extension

19. SURGICAL TREATMENT Clinical stage II
Radical hysterectomy and bilateral salpingo-oophorectomy has been recommended
Pelvic and para-aortic lymphadenectomy is necessary
Make sure to obtain peritoneal washings
Open the uterus in the operation
Expect the PR and ER receptors.

20. SURGICAL TREATMENT Clinical stage Ⅲ，Ⅳ
cytoreductive surgery should be attempted if possible

21. RADIATION THERAPY
Radiation therapy simply is used in patients with operation forbiddance or in the late stages.
Postoperative adjuvant radiation therapy is indicated in patients with
extrauterine extension
lower uterine segment or cervical involvement
myometrial invasion >1/2
poor histologic differentiation
papillary serous or clear cell histology

22. RADIATION THERAPY
Adjuvant radiation therapy preoperatively is indicated in reducing tumor size to create operation condition and eliminate the hiding metastasis lesion.
Radiation therapy can be carried out inside or outside body.

23. HORMONE THERAPY
Progesterone has been the treatment of recurrent endometrial carcinoma not amenable to irradiation or surgery. Patients who are young also use progesterone therapy to keep fertility. The drugs are manual composed with high dose. curative effect should be estimated every 2-3 months
Tamoxifen has been used as another hormonal agent in advanced or recurrent endometrial cancer

24. ANTITUMOR CHEMOTHERAPY
Chemotherapy of single drug or combined drugs is appropriate in the advanced or recurrent endometrial cancer.

25. Follow-up Time ： 2-3rd year: once every 3 months
3-5th year: once every 6 months
>5th year: once every year
Content ：
pelvic examination
cytological exam of the residual vagina
chest X-Ray, CA125