Updated: 8/25/2018

Endometrial Carcinoma

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Snap Shot
  • A 72-year-old woman was evaluated for post-menopausal bleeding. A fractional dilatation and curettage revealed endometrial carcinoma. Her cervical Pap smear was normal. She had not been on any hormone replacement therapy. An ultrasound is performed.
Introduction
  • Fourth most common malignancy in women after breast, colorectal, and lung cancer
  • Most common gynecologic malignancy
  • An estrogen dependent cancer affecting mainly postmenopausal women
    • incidence peaks between ages 50 and 60
  • Risk factors include
    • increased estrogen exposure 
      • unopposed postmenopausal estrogen replacement
      • obesity
      • nulliparity
      • late menopause (after 52 yrs)
      • polycystic ovarian syndrome
      • estrogen-producing tumors
      • anovulation
    • cancer syndromes
      • hereditary nonpolyposis colon cancer
    • OCPs decrease risk 
      • secondary to protective effects of progestins
  • 2 types of endometrial carcinomas 
    • type 1 endometroid adenocarcinomas (estrogen dependent, low grade, derived from atypical endometrial hyperplasia, and minimal invasion)
      • endometroid adenocarcinoma
        • accounts for 75%
        • glands resemble normal endometrium
        • may have different variants with
          • squamous differentiation
          • villoglandular or secretory types
    • type 2 serous or clear cell in histology (estrogen independent, high grade, not derived from endometrial hyperplasia, and invasive)
      • serous carcinoma
        • accounts for 5-10%
        • arises from atrophic endometrium of older women
        • complex pattern of papillary growth and nuclear atypia
      • clear cell carcinoma
        • accounts for < 5%
        • can be solid, cystic, tubular, papillary or a mixture
  • Lungs are most common site of metastasis
Presentation
  • Symptoms
    • abnormal uterine bleeding
    • post-menopausal bleeding
Evaluation
  • Endometrial biopsy
    • gold standard
Treatment
  • Surgery
  • Radiation
  • Chemotherapy
    • carboplatin and placlitaxel

 

 

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