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

Ovarian: commonest 50-69 years

Cervix: 15-34 years & >50 yrs

Endometrium: >45 yers.. Majority >60 yrs of age

Risk Indicators for Endometrial Cancer and Precursors

  Age   60 yearsObesity (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)

Risk FactorApproximate Risk Ratios

Obesity 1.8–2.4

Nulliparity 2.0–3.0

Diabetes mellitus 2.8

Prior irradiation 8.0

Granulosa-theca cell tumors 5.0

Exogenous estrogen therapy 3.0–8.0

Late menopause (>age 52) 2.4

Summary of Probable Risk Factors Associated with Endometrial Cancer

Endometrial hyperplasia

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

Endometrial hyperplasia

Cystic hyperplasia Simple hyperplasia

Atypical hyperplasia Simple hyperplasia

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

Corpus cancer

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

According to the U.S. Gynecologic Oncology Group histologic grading system,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.

Irregular vaginal bleeding,,,, intermenstrual or post menopausal

Watery vaginal discharge may be present in postmenopausal women

Mass in late stages

T.V.S. and biopsy

Hysteroscopy and biopsy

? M.R.I. Or C.T. scan

Hysteroscopy and biopsy

T.V.S. and biopsy

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

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%