(必备)妇科恶性肿瘤课件

1、Endometrial Carcinoma Womens Hospital, School of Medicine, Zhejiang university 第1页，共24页。General Considerations Endometrial carcinoma is one of the most three common pelvic genital cancer in women.It is malignant epithelioid tumor. The incidence of endometrial cancer has now raised. The peak incidenc

2、e of onset is in the age 58-61 years.第2页，共24页。Etiology Etiology of endometrial carcinoma may involve two mechanisms estrogen-dependent estrogen-independentcertain第3页，共24页。PathologyEndometrioid adenocarcinomaSerous adenocarcinomaClear cell carcinomasMucus adenocarcinoma Others第4页，共24页。METASTASISDirec

3、t invasionLymphatic metastasis Vascular metastasis(advanced stage)第5页，共24页。SYMPTOMS mostly of the disease occurs in the elder patients,there is no symptoms at the very early stage and it is only discovered by examine. abnormal vaginal bleeding vaginal fluiding. pelvic painweakness, weight loss, and

4、anemia第6页，共24页。 Physical examination is usually unremarkable at the very early stage. the uterus may be enlarged and the mass may move out of the cavity in the advanced cases.Some signs of metastasis can be found of the late stages of the diseaseSIGNS 第7页，共24页。Diagnosis History：clinical representati

5、on and high risk factor, family historyvaginal bleedingHigh-risk factorsLong term use of E2,TAMFamily history of breast cancer and endometrial carcinomasSigns 第8页，共24页。Special ExaminationsFractional curettage Endometrial biopsyEndocervical curettageDiagnose of endometrial carcinoma needs the patholo

6、gic results第9页，共24页。Endometrial cytology exam are also used in some patients. Ultrasonography can be helpful in deciding clinical staging, In postmenopausal women, 4mm is the cut off for a normal unilateral endometrial stripe. The function of cavityscopy is controversy. MRI and CT appear to improve

7、the accuracy of clinical staging and is particularly helpful in identifying myometrial invasion. Serum CA-125, a well-established tumor marker can also be useful for endometrial cancer. Special Examinations第10页，共24页。DifferentiationDysfunctional uterine bleeding in the menopause women Senile vaginiti

8、sEndometrial polypusPelvic genital cancer in womenEndometritis in elders第11页，共24页。CLINICAL STAGE According to anatomic sitesStage I： endometriumStage II： cervixStage III: parametrial，within pelvisStage IV：beyond metastasis第12页，共24页。Clinical staging(FIGO1971)According to the Fractional curettage and

9、clinical examinationPre-operation stagingUsed in the patients who treat Radiation as primary therapySurgical-pathological staging (FIGO1988)the last staging for the patients who choose surgery as the principal therapyIt is the last staging for the majorityStaging第13页，共24页。THERAPY Treatment plan for

10、endometrial carcinoma depends on its clinical staging and common conditionSurgery , radiation therapy and drugs are all in usePrimary surgery with concomitant therapy is the main treatment in the early stage patients While in the late stages of the disease include radiation, surgery and drugs therap

11、y. 第14页，共24页。Surgical treatment :Primary treatment, especially in the early stagesPurposeDefinitude the staging and prognostic factorsExcise the lesion THERAPY第15页，共24页。SURGICAL TREATMENT clinical stage simple hysterectomy and bilateral salpingo-oophorectomy has been recommended Make sure to obtain

12、peritoneal washings for cytologic identification of occult spread. The uterus should be opened in the operating room to determine the need for lymphadenectomy. 第16页，共24页。 The need for lymphadenectomySpecial pathological typeGreater than 50% myometrial invasion Low differentiation（G3） 50 cavity be in

13、volved by the lesionCervical extension SURGICAL TREATMENT 第17页，共24页。SURGICAL TREATMENT clinical stage II radical hysterectomy and bilateral salpingo-oophorectomy has been recommended pelvic and para-aortic lymphadenectomy is necessary Make sure to obtain peritoneal washings open the uterus in the op

14、eration and expect the PR and ER receptors. 第18页，共24页。SURGICAL TREATMENT clinical stage ， cytoreductive surgery should be attempted if possible 第19页，共24页。Radiation therapy simply is used in patients with operation forbiddance or in the late stages. Postoperative adjuvant radiation therapy is indicat

15、ed in patients with extrauterine extension lower uterine segment or cervical involvement myometrial invasion 1/2 poor histologic differentiation papillary serous or clear cell histology RADIATION THERAPY 第20页，共24页。Adjuvant radiation therapy preoperatively is indicated in reducing tumor size to creat

16、e operation condition and eliminate the hiding metastasis lesion. Radiation therapy can be carried out inside or outside body.RADIATION THERAPY 第21页，共24页。HORMONE THERAPY Progesterone has been the treatment of recurrent endometrial carcinoma not amenable to irradiation or surgery. Patients who are yo

17、ung also use progesterone therapy to keep fertility. The drugs are manual composed with high dose. curative effect should be estimated every 2-3months. Tamoxifen has been used as another hormonal agent in advanced or recurrent endometrial cancer 第22页，共24页。ANTITUMOR CHEMOTHERAPY Chemotherapy of single drug or combined drugs is app