Endometrial Cancer Flashcards
Risk factors:
Older age
Early menarche& late menopause (2 fold)
Unopposed estrogen therapy (10-30 fold) if treatment contineus 5y or more
Nulliparity. White race
Tamoxifen use
Previous pelvic irradiation
Hypertension & DM, chronic liver disease
Lynch syndrome
obesity PCOS HRT
More risk factors:
estrogen-producing tumors or ovarian granulosa, and theca cells tumour
High intake of animal fat and fired food
Buttrt intake (two studies)
Higher BMI
Why PCOS?
Prolonged anovulation with consequent exposure to estrogen unopposed by progestrone
Peripheral conversion of androgens tk estroges
Why androgenism ?
Androgen receptor and 5a-reductase are present in human endometrium,
In PCOS women, with over expression of endometrial androgen receptors, disordered androgen action within the endometrium may result in EC
Why +++Insuline?
High levels of insuline by IR have direct and indirect effects for the EC
**It stimulates endometrial cell proliferation
Why obesity
Adipose tissue express aromatase
Low level of SHBG
Low level of insulin-binding globulins
Protective factors:
CCOP
Smoking 🫠: ++ concentration of SHBG
++ coffee consumption
Hugh vegetable intake
High carbohydrates intake predominanlty breads and cereals,
EC types according to the histopathology:
Endomterioid adenocarcinoma (80-85%)
Adenocarcinoma with squamous differentiation (common)
Adenosquamous carcinoma (rare)
Serous carcinoma
Clear cell carcinoma
Malignant mixed müllerian tumor (MMTs)
Routes of spread
Direct:
to myometrium and serosa > perforation and peritonitis (common cause of death)
To cervix > block >pyometra
Lymphatic(late):
A.paracervical, parametral, pelic LN3
B. Ovarian para-aortic LN
C. Round ligament-inguinal LN
Hematogenous
Implantation
Clinical presentation:
Postmenopausal Nullipara obese woman
Hx of early menarche & late…
DM & HTN
Abnormal bleeding:
Postmenopausal
Menorrhagia
Post-coital spotting
Intermenstrual bleeding
More signs:
Blood stained VD
Cervical stenosis? Hematometra, pyometra, or purulent VD
Colicky abdominal pain
Pallor
How to exam?
Speculum exam: looking for blood or discharge
Bimanual exam:either atrophic, normal, or enlarged uterus: mobile unless late stage
per-rectal exam
Regional lymph nodes & breast exam
How to dx?
Hx and PE
CBC
Transvaginal US (thickness)
Endometrial biopsy
Hysteroscopy & endometrial biopsy (Gold standard)
Findings suggestive of endometrial carcinoma:
Endometrial thickness >5mm
Hyper-echogenic Endometrium with irregular ouline.
++ vascularity with low vascular resistance (doppler)
Intrauterine fliud
Why using MRI?
To identify pateints preoperatively and avoid over treating early stage patients (unnecessary lymphadenectomies)
Differentiating benign mimics of fibroid, adenomyosis, polyp & EH
