Most common malignancy of
the lower female genital tract in the US
neoplastic DISEASES OF THE UTERUS
US :
first
endometrial,
second ovarian,
third is cervical.
Philippines the most common is cervical, being in the
Visayas region.
Excess of estrogen
Premalignant lesion
ENDOMETRIAL HYPERPLASIA [EH]
Classifications of Endometrial Hyperplasias (World Health
Organization)
Simple
Complex
Atypical simple
Atypical complex
Cystic hyperplasia
Presence of dilated glands that may contain
some outpouching and abundant endometrial
stroma
Common in a hyperplastic endometrium in a
menopausal and postmenopausal woman
(cystic atrophy)
Weakly premalignant
Simple Hyperplasia
Glands are crowded with very little endometrial
stroma and a complex gland pattern and
outpouching formations
Low malignant potential
No irregularities in shape, do not appear atypical
(look at the N:C ratio = 1:3)
Complex Hyperplasia [Without Atypia]
Glands with cytologic atypia
Premalignant
Increase in the N/C (nuclear/ cytoplasmic) ratio
with irregularity in the size and shape of the
nuclei
Complex Atypical Hyperplasia
Endometrial hyperplasia
: most frequent symptom
AUB
???? - : adjunct for thediagnosis
???? - evaluated if with vaginal bleeding
Transvaginal ultrasonography (TVS): adjunct for the
diagnosis
endometrial sampling or dilatation and curettage evaluated if with vaginal bleeding
Reproductive age:
Postreproductive yearrs:
Reproductive age: preservation of the uterus desired
Postreproductive years: uterine preservation not desired
NO ATYPIA mx
Simple:
No abnormal bleeding:
Abnormal bleeding:
NO ATYPIA
No abnormal bleeding: observe
Abnormal bleeding: intermittent progestin therapy
no atypia Mx
Complex
-
no atypia
-Intermittent or continuous progestin therapy,
-consider 3 to 6-month sample especially for AUB
-Hysterectomy for recurrent hyperplasia or AUB
WITH ATYPIA
Simple of mild mx
-Intermittent or continuous progestin therapy;
-sample 3 to 6 months
with atypia tx
mild
mod
complex, mod or severe
mild - progesterone or hysterectomy
mod - hysterectomy
complex, mod or severe- continuous high dose progestin theraphy, samole 3 to 6 months
ENDOMETRIAL CARCINOMA
Staging
o STAGE I:
o STAGE II:
o STAGE IV:
o STAGE III:
STAGE I: organ itself
STAGE II: involvement to the nearest organ; cervix is affected/included managed as cervical cancer
STAGE III: Lymph Node or extension to pelvic wall
STAGE IV: METASTASIS
Histologic type
Best prognosis
o Endometrioid adenoCA
- Better differentiated tumors with or without squamous element and secretory CA
Histologic Grade
DEGREE OF DIFFERENTIATION:
Well differentiated
% OF SOLID COMPONENTS:
Less than 50 %
GRADE 1
Intermediate differentiation
6 - 50 %
GRADE 2
DEGREE OF DIFFERENTIATION
Poorly differentiated
% OF SOLID COMPONENTS
More than 50%
GRADE 3
Patterns of Spread
Endometrial CA
Distant metastases
Lungs
Retroperitoneal nodes
Abdomen
endometrial CA
Evaluation
CXR
Chest and abdominal pelvic CT scan
endometrial ca
mx
Less than 5% of uterine malignancy
SARCOMA
Treated with
Treated with operation
o Removal of the uterus, tubes and ovaries
metastatic sarcomas
tx
complete responses are rare and usually temporary
Multiagent chemotherapeutic regimens
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