a significant increase in the incidence of endometrial cancer. this increased incidence of...
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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
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Ovarian: commonest 50-69 years
Cervix: 15-34 years & >50 yrs
Endometrium: >45 yers.. Majority >60 yrs of age
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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)
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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
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Endometrial hyperplasia
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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
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Endometrial hyperplasia
Cystic hyperplasia Simple hyperplasia
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Atypical hyperplasia Simple hyperplasia
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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
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Corpus cancer
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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
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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.
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Irregular vaginal bleeding,,,, intermenstrual or post menopausal
Watery vaginal discharge may be present in postmenopausal women
Mass in late stages
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T.V.S. and biopsy
Hysteroscopy and biopsy
? M.R.I. Or C.T. scan
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Hysteroscopy and biopsy
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T.V.S. and biopsy
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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
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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%