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Endometrial Cancer OB/GYN Hospital Fudan University Xin LU, MD, Ph.D. Endometriod cancer-Contents Incidence Risk factors Classification Symptoms Pathology FIGO Staging Diagnosis Treatment WHO Cancer Report Global cancer rates could increase by 50% to 15 million by 2020 Endometrial cancer is the 4th most common cancer in women New Diagnosed cases: 142,000 Died cases each year: 42,000 incidence 2-3% Average age: 60s Histologic Types Endometrial Cancers Endometrioid (87%) Adenosquamous (4%) Papillary Serous (3%) Clear Cell (2%) Mucinous (1%) Other (3%) Endometrial Cancer:Type I/II Type I Estrogen Related Younger and heavier patients Low grade Background of Hyperplasia Perimenopausal Exogenous estrogen Familial/genetic (15% ) Lynch II syndrome/HNPCC Familial trend Type II (10% ) Aggressive High grade Unfavorable Histology Unrelated to estrogen stimulation Occurs in older & thinner women Endometrial Cancer: Risk Factors Risk FactorsRelative Risk X Obesity 2-5 PCOS 5 Estrogen use10-20 Nulliparous3 Infertility2-3 Diabetes/Hypertension1.3-3 Nulliparous3 Early Menarche ( 50% solid tumor NUCLEAR GRADE Size, shape , staining and chromatin, variability, prominent nucleoli. High nuclear grade adds one point to FIGO grade CA125 Chest X-ray Mammograms Colon Evaluation Others as indicated Uterine Cancer: Pre-op Evaluation Uterine Cancer: Pre-op Evaluation Transvaginal U/S? CT Scan? MRI? Uterine Cancer: Pre-op Evaluation Uterine Cancer: Surgical Staging Preoperative preparation Antimicrobial prophylaxis DVT prophylaxis Steep Trendelenburg Long instruments available Availability of frozen section to determine the extent of staging procedure. Capability of complete surgical staging Capability of tumor reduction if indicated Endometrial Cancer: Intra-operative Surgical Principals Endometrial Cancer: Surgical Approach TAH-BSO/washings only Endometrioid* Grades 1 and 50% myometrial invasion Any 2 cm tumor diameter All Serous/clear cell subtype* Pre operative assessment of advanced disease (gross cervical or vaginal dz, etc) *TAH-BSO, washings, lymphadenectomy *omental/peritoneal biopsy Endometrial Cancer: Adjuvant Therapy Brachytherapy External beam radiotherapy Hormonal therapy Cytotoxic chemotherapy Combination therapy Endometrial Cancer: Recurrence Pelvic examination Pap smears CA125 (high-risk) Chest X-ray (high-risk) Endometrial Cancer: Site of Recurrence In Radiated Patients Site% Distant65 Pelvic and distant15 Pelvis only15 Vagina5 Endometrial Cancer: Follow-Up 75-95% of recurrences are in first 36 m