Endometrium Cancer

Prepare;

Endometrium

Inner membrane of the mammalian uterus.

Endometrium Lining for the uterus Preventing adhesions between the

opposed walls of the myometrium. Soft and spongy. Each month endometrium change as part

of menstrual cycle.

What is Endometrial Cancer?

Cause

Estrogen

The exact cause is unknown.

Risk Factors Sex, Age, Family History

Irregular menstrual periods Early first menstruation or late menopauseInfertility

Obesity Diabetes Hypertension

Estrogen replacement therapy and/or Tamoxifen

-to treat the symptoms of menopause.-help prevent osteoporosis.-by taking the hormone progestogen along with estrogen, the risk of endometrial cancer is reduced substantially

Women who have been treated with tamoxifen, a drug used to prevent and treat breast cancer, may have a slightly increased risk of developing endometrial cancer.

DiagnosisHYSTEROSCOPE-an endoscope is used to guide the endometrial biopsy or D&C. -he tube is inserted into the uterus through the Cervix.-A hysteroscopy allows the doctor to view the inside of the uterus while collecting endometrial tissue samples.

Endometrial stromal sarcoma gross

Signs and symptoms• Vaginal bleeding and/or spotting in

postmenopausal women. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.

• Abnormal uterine bleeding, abnormal menstrual periods.

Bleeding between normal periods in premenopausal women in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes).

Anemia, caused by chronic loss of blood. (This may occur if the woman has ignored symptoms of prolonged or frequent abnormal menstrual bleeding.)

Lower abdominal pain or pelvic cramping. Thin white or clear vaginal discharge in

postmenopausal women. Weight loss.

TYPE OF ENDOMETRIAL CANCERType 1caused by excess estrogen

Type 2experts aren't sure what causes type 2 cancers, but they don't seem to be caused by too much estrogen

TYPE I

not very aggressive

slow to spread to other tissues

grades 1 and 2 endometrial cancers are "type 1" endometrial cancer

occur most commonly in pre- and peri-menopausal women

history of unopposed estrogen exposure and/or endometrial hyperplasia

carry a good prognosis.

TYPE II

occur in older, post-menopausal women

more common in African-Americans

more likely to grow and spread outside of the uterus

carry a poorer prognosis

Example of type I cancer

Endometrial adenocarcinoma

Endometrial adenocarcinoma most common type of uterine cancer

it arises from the glands of the endometrium

About 80% of uterine cancers are adenocarcinomas, and they have varying aggressiveness.

The pathologist assigns a "grade" to this cancer, which basically says how cancerous it looks under the microscope.

While "Grade I" looks a lot like normal uterine tissue and can be

very indolent, "Grade III" looks very cancerous and will probably be aggressive. "Grade II" is intermediate in looks and behavior.

About 40% of adenocarcinomas are "Grade I," 20% are "Grade II," and 40% are "Grade III

Example of type II cancer

the uterine papillary serous carcinoma

the uterine clear cell carcinoma

High-grade endometrioid cancer

Uterine papillary serous carcinoma

Uterine papillary serous carcinoma

uterine papillary serous carcinoma (UPSC) is an uncommon form of endometrial cancer that typically arises in postmenopausal women.

is the worst type since it is very aggressive and tends to come back even when caught early. It represents 5% of uterine cancers.

It is typically diagnosed on endometrial biopsy, prompted by post-menopausal bleeding.

It arises in the setting of endometrial atrophy and is classified as a type II endometrial cancer.

uterine clear cell carcinoma

uterine clear cell carcinoma Uterine clear cell carcinoma (CC) is a rare form of

endometrial cancer with distinct morphological features on pathology; it is aggressive and has high recurrence rate.

is an aggressive cancer accounting for about 2% of uterine cancers.

It is associated with a woman's mother having used a hormone called DES while pregnant, and is getting less common with DES no longer used.

Like uterine papillary serous carcinoma CC does not develop from endometrial hyperplasia and is not hormone sensitive, rather it arises from an atrophic endometrium.

Treatment for endometrial cancer

Depends on the stage of the disease and the overall health of the patient.

Primary treatment is the surgery (removal of the tumor ). 

Radiation therapy, hormone therapy, and/or chemotherapy may be used as adjuvant treatment (i.e., in addition to surgery) in patients with metastatic or recurrent disease.

Surgery

Surgery (removing the tumor in an operation) for endometrial cancer is also known as hysterectomy which the uterus is surgically removed with or without other organs or tissues.

Total hysterectomy: Surgery to remove the uterus, including the cervix

unilateral

bilateral

Total hysterectomy with salpingo-oophorectomy:

the uterus and cervix plus one ovary and fallopian tube are removed

the uterus and cervix plus both ovaries and fallopian tubes are removed

Radical hysterectomy: The uterus, cervix, both ovaries, both fallopian tubes, plus part of the vagina, and nearby tissue are removed

Part of vagina

These procedures are done using a low transverse incision or a vertical incision

Chemotherapy

Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.

Treatment usually involves a combination of two or three chemotherapy drugs.

This treatment may be considered in some cases, especially for those with stage 3 and 4 disease.

Chemotherapy also may be used in addition to surgery (called adjuvant therapy) to treat metastatic endometrial cancer and to prevent recurrent disease.

Adjuvant chemotherapy for endometrial cancer is usually given for a total of six to eight 21-day cycles (the treatment is given once every 21 days for a total of six to eight treatments).

The following drugs are used to treat endometrial cancer:

Carboplatin (Paraplatin®) Cisplatin (Platinol®) Doxorubicin (Doxil®) Cyclophosphamide (Cytoxin®) Paclitaxel (Taxol®, Paxene®)

RADIATION THERAPY

Compared with low-risk endometrial cancer, intermediate-risk cancers have a higher chance of coming back after surgery.

Intermediate-risk endometrial – cancer has invaded more deeply into the lining of the

uterus, or – evidence of cancer invasion into the cervix when the

hysterectomy specimen is examined under a microscope.

Radiation therapy is recommended for some women after surgery. This practice is called "adjuvant" radiation therapy. – The purpose is to get rid of any tumor cells that might be

left in the body after surgery.

Adjuvant radiation therapy (RT)

Vaginal brachytherapy

Low-dose rate brachytherapy uses a device that delivers radiation through the vagina continuously for two or three days, 24 hours per day.

High-dose rate brachytherapy uses a device that delivers radiation in the vagina for only a few minutes at a time once a day, and treatment is generally repeated three to five times. This treatment is generally given as an outpatient and do not have to stay in the hospital overnight.

External beam RT

During EBRT, your body is positioned beneath the X-ray machine in the same way every day, and the radiation field is exposed to the radiation beam for a few seconds once per day, five days per week, for five to six weeks.

The choice between external beam RT and vaginal brachytherapy depends on a number of factors. However, for most women with intermediate-risk disease, vaginal brachytherapy seems to be as effective as external beam RT.

Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing.

Hormones are substances made by glands in the body and circulated in the bloodstream.

Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where

hormones can attach (receptors), drugs, surgery, or radiation therapy is used to reduce the production of hormones or block them from working.

Progestins The main hormone treatment for endometrial cancer Eg - medroxyprogesterone acetate (Provera®) and megestrol

acetate (Megace®). Slowing the growth of endometrial cancer cells. Side effects

can include increased blood sugar levels in patients with diabetes.

Tamoxifen An anti-estrogen drug often used to treat breast cancer, may

also be used to treat advanced or recurrent endometrial cancer.

Prevent any estrogens circulating in the woman's body from stimulating growth of the cancer cells and nourishing the cancer cells.

It does not cause bone loss, but can cause hot flashes, vaginal dryness and increased risk of serious blood clots in the leg.

Gonadotropin-releasing hormone agonists These drugs switch off estrogen production by the ovaries in women who are

premenopausal. Eg- goserelin (Zoladex) and leuprolide (Lupron). These drugs are injected every 1 to

3 months. Side effects can include hot flashes and vaginal dryness. If they are taken for a long

time (years), these drugs can weaken bones (leading to osteoporosis).

Aromatase inhibitors After the ovaries are removed estrogen is still made in fat tissue. Stop this estrogen from being formed and lower estrogen levels even further. Eg - letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). These drugs are most often used to treat breast cancer, but may be helpful in the

treatment of endometrial cancer. Side effects can include joint and muscle pain and hot flashes. If they are taken for a

long time (years), these drugs can weaken bones (leading to osteoporosis). These drugs are still being studied for use in treating endometrial cancer

Refferance

http://www.emedicinehealth.com/endometrial_cancer/page2_em.htm.

http://www.medicinenet.com/uterine_cancer/article.htm.

The End