1. 1. NOOR MUHAMMAD WAZIR 08-143 BATCH: I FINAL YEAR MBBS GYNAE:C
2. 2. ENDOMETRIAL CARCINOMA
3. 3. ANATOMY OF UTERUS GROSS HISTOLOGIC
4. 4. ENDOMETRIAL HYPERPLASIA A spectrum of proliferative abnormalities of endometrium are subdivided into: CYSTIC HYPERPLASIA: increase in the number of glands. ADENOMATOUS HYPERPLASIA: back to back crowding of glands with little intervening stroma. ATYPICAL HYPERPLASIA: glands show nuclear
5. 5. CAUSES AND RISK FACTORS OF ENDOMETRIAL CARCINOMA
6. 6. EFFECTS OF ESTROGEN ON ENDOMETRIUM
7. 7. M Other causes : Myomas Senile endometritis Dietary factors
8. 8. PATHOLOGY GROSS FEATURES: DIFFUSE TYPE: Involves most of endometrium. May reach the myometrium and serous surface. PYOMETRA: uterus is enlarged due to the formation of pyometra which is formed following an infection of the tumor with accumulation of pus due to stenosis of internal cervical os LOCALIZED TYPE: It is limited to small area where it forms a polypoidal growth. polyp is friable, ulcerated and necrosed.
9. 9. MICROSCOPIC FEATURES: 1.Adenocarcinoma(ca. arising from glandular tissue) 2.adenocanthoma. 3.Adenosquamous carcinoma Histological grading of adenocarcinoma depends upon degre of differentiation. GRADE 1: 50% non squamous undifferentiated
10. 10. SPREAD DIRECT: Cervical canal: here the tumor may get infected and blocks the Cervix leading to pyometra formation Myometrium Ovaries LYMPHATIC SPREAD: inguinal lymph nodes para aortic lymph nodes. BLOOD BORNE: Lungs, Liver, Bone etc IMPLANTATION: During hysterectomy malignant cells may get implanted in the vaginal vault causing recurrence.
11. 11. CLINICAL FEATURES SYMPTOMS BLEEDING: due to ulceration and sloughing off of the carcinoma. Irregular vaginal bleeding. Post menopausal bleeding. MENORHAGIA in premenopausal patients. VAGINAL DISCHARGE: Brownish or blood stained, offensive or purulent due to pyometra.
12. 12. PAIN: late symptom. Indicates advanced growth with metastasis. Dull, colicky lower abdominal pain. Occurs due to strong contractions of uterus to expel the polypoid growth or pyometra. ASYMPTOMATIC
13. 13. PHYSICAL EXAMINATION Palpation of supraclavicular and groin nodes. Breast is examined for a co-existent primary or secondary lesion. Speculum examination: done for metastatic invasion of vagina.in case of pyometra a pyogenic or blood stained discharge pours from the cervix.
14. 14. BIMANUAL PELVIC EXAMINATION: To assess the size,consistency and mobility of uterus. Findings: large size, soft consistency in case of pyometra Reduced mobility if the tumor has extended beyond
15. 15. CLINICAL STAGING
16. 16. DIAGNOSTIC TECHNIQUES ENDOMETRIAL SAMPLING: Fractional curettage: The endometrial curetting are bulky and necrotic.
17. 17. HYSTEROSCOP Y: Extent of the disease and site of invasion can be biopsied easily
18. 18. TRANSVAGINAL ULTRASOUND(TVS): Uterine enlargement Thick hyper echoic endometrial lining. Loss of subendometrial halo in case of myometrial
19. 19. CERVICAL SMEAR: RADIOLOGICAL EXAMINATIONS: X-RAY CHEST,MRI, IVU
20. 20. TUMOUR MARKERS: CA-125 is a non specific tumor marker. Patients with clinical stage 4 disease show raised levels. OTHER TESTS: CBC Blood group Blood sugar level Serum creatinine Urea Electrolytes ECG
21. 21. GENERAL MEASURES SURGERY SURGERY AND RADIOTHERAPY CHEMOTHERAPY According to the stage of the disease TREATMENT
22. 22. GENERAL MEASURES General health should be improved LFTs RFTs Blood glucose
23. 23. STAGE TREATMENT PLAN STAGE 1a grade 1 TAH/BSO OTHER STAGE 1 TAH/BSO,radiotherapy STAGE 2 radical hysterectomy/BSO ,pelvic lymphadenectomy radiotherapy STAGE 3 Radiotherapy:if only pelvis is involved Laparotomy;if disease spreads beyond pelvis(omentectomy,lymphadenecto my) STAGE 4 radiotherapy,chemotherapy,debulki ng surgery,hormonal therapy
24. 24. FIVE YEAR SURVIVAL RATES STAGE RATES 1 82-86% 2 70% 3 40% 4 16-27%
25. 25. SURGICAL OPTIONS
26. 26. RADIOTHERAPY OPTIONS COMBINED WITH SURGERY: Treatment of choice for stage 1C or stage 2 in which more than half of the myometrium and cervical glands and stroma are involved. RADIOTHERAPY ALONE: If the growth is wide spread in the pelvis(stage 3,4) or if the patient is too weak to undergo surgery. ROUTES: BRACHYTHERAPY:intracavitary TELETHERAPY:by external routes
27. 27. CHEMOTHERAPY OPTIONS PROGESTOGEN: For relief of pain in advanced cases. 2-3 injections are given before or after surgery or radiotherapy. Minimum duration of treatment is more than 3 months. PREPARATIONS: Inj.medroxyprogesterone acetate 200 mg im weekly(depoProvera) Inj.hydroxyprogesterone caproate 250 mg im weekly(proluton Depot) Tab.norethisterone10 mg tid.(primolute
28. 28. FOLLOW UP TO DETECT THE RECURRENCE: Vaginal recurrence is common so it should be examined at every visit. TO DETECT COMPLICATIONS OF THERAPY: Hematuria, Cystitis, Diarrhea, Melena Rectal spasm, Ilietus, Vaginal stenosis, Lymphedema etc