Endometrial CanceršŸ˜Š

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Endometrial Cancer

  • Size of uterus:
    • 3x2x1
    • 5 cm
  • Weight: 60 gms
  • Fundus & body - 3.5 cm
  • Isthmus - 0.5 cm
  • Cervix - 2.5 cm

Overview & Key Points

  • Most Common Malignancy:
    • Most common gynaecological cancer: Adenocarcinoma.
    • Most malignant : Papillary serous, Clear cell.
    • Tumor marker: CA-125 (non-specific, useful for monitoring).
  • Age:
    • Most common in 50-70 years.
    • Most common complaint: AUB-m (Abnormal Uterine Bleeding in menstruating women).
    • Most specific complaint: Postmenopausal bleeding.
  • Prognosis:
    • Generally good prognosis,
    • especially for Type I.
  • Route of Spread:
    • Direct >> Lymphatic spread

Risk Factors

  • Family History:
    • Lynch Syndrome
    • BRCA 1/2 mutations
    • Cowden Syndrome
  • Gatekeeper Gene:Ā PTEN.
  • Obesity
  • Hypertension
  • Diabetes
  • Tamoxifen use
  • Estrogen Exposure (Unopposed Estrogen):
    • Late menopause / Early menarche
    • Atypical endometrial hyperplasia
    • Polycystic Ovary Syndrome (PCOS)
    • Hormone Replacement Therapy (HRT) with estrogen only
    • Granulosa cell tumor
    • Note: R/F for both Endometrial and ovarian cancer
      • Nulliparity
      • Infertility

Protective

  • OCPs
  • Multiparity
  • Breast feeding
  • Physical activity
  • Smoking
    • ā†‘ R/o
      • Vulval cancer
      • SCC Cervix
      • Mucinous ovarian cancer

Types of Endometrial Cancer

Feature
Type I Endometrial Ca
Type II Endometrial Ca
Mutation
KRAS / PTEN
P53
Histology
Endometrioid adenocarcinoma
Papillary serous or Clear cell adenocarcinoma
Grade
Low grade (1, 2)
High grade (3)
Precursor
Endometrial hyperplasia
Endometrial atrophy
Estrogen relation
A/w excess estrogen exposure
-
Frequency
Most common type
Less common
Prognosis
Good prognosis
Poor prognosis

Important Stages Endometrium (FIGO Staging - 2009)

  • Stage I:Ā Tumor confined to the uterus.
    • IA:Ā <50% myometrial involvement.
    • IB:Ā ā‰„50% myometrial involvement.
  • Stage II:Ā Cervical stromal involvement (Glands & stroma).
  • Stage III:Ā Local and/or regional spread.
    • IIIA:Ā Serosa / Adnexa involvement.
    • IIIB:Ā Vaginal / Parametrium involvement.
    • IIIC:Ā Lymph node (LN) involvement.
      • IIIC1:Ā Pelvic LN.
      • IIIC2:Ā Para-aortic LN.
    • Mnemonic: Sakshi (Serosa) Agarwal (Adnexa) is Very (Vaginal) Pretty (Parametrial) Lady (LN)
  • Stage IV:Ā Metastasis.
    • IVA:Ā Regional (Bladder / Bowel).
    • IVB:Ā Distant metastasis (including Superficial inguinal LN).
    • Note: Superficial inguinal LN involvement in endometrial, ovarian and cervical carcinoma ā†’ Stage 4b
    • Stage 3 is same in all gyni cancers

Management (Surgical Staging)

  • Key Components:
    • Surgical staging
      • Surgery
      • Lymph Node (LN) Dissection
    • Post-operative Therapy

1. Surgery

  • Stage 1:Ā TAH + BSO
  • Stage 2/3:Ā Wertheim's hysterectomy (Radical hysterectomy).
  • Stage 4:Ā Debulking Surgery.

2. Lymph Node Dissection (LND)

  • Default:Ā Pelvic & Para-aortic LND in all stages except Stage 1a
  • Exception (Stage IA only):
    • If tumor size < 2 cm: No LND needed.
    • If tumor size ā‰„ 2 cm: Pelvic LND only.

3. Post-Operative Therapy

  • Low risk
    • No Post-Op Therapy:
      • IfĀ all 3Ā conditions are fulfilled:
        • Adenocarcinoma
          • Grade: 1 or 2
        • Stage: IA
  • High Risk (any of following):
    • Adenocarcinoma Grade 3
    • Papillary/ serous / Clear cell tumor
    • Stage 3 / 4 (any tumor type)
    • Management:
      • Chemotherapy
        • (Cisplatin + Paclitaxel)
      • PLUS Radiotherapy
  • Rest All (Intermediate Risk):
    • Management:Ā 
      • External Beam Radiotherapy (EBRT).

Corpus Cancer Syndrome

  • Increased endometrial carcinoma risk in:
    • Obese
    • Diabetes Mellitus
    • Hypertension