Endometrial Cancer is a group of cancers that arise from in the lining of the Uterus called the Endometrium.

May also be known to or referred to as Uterine Cancer.

This type of cancer is the 2nd most common cancer in the genital tract.

Typically seen in women of age 50-70.

Over 35,000 women are diagnosed every year with this cancer.

Some women may have taken unopposed Estrogen in the past.

80% of cases are of the subtype – Endometrioid Carcinoma

 

Additional Risk Factors

  • Obesity
  • Diabetes
  • Bearing no having children
  • Polycystic ovaries
  • Prolonged use of tamoxifen (for breast cancer)
  • and others.

Symptoms

  • Abnormal vaginal bleeding or spotting
  • Anemia
  • Abdominal pain
  • Vaginal discharge [white or clear]

Tissue (endometrial) sampling is important for prevention in those with abnormal bleeding.

 

Types

Carcinoma

  • Usually Adenocarcinomas – originate from a single layer of epithelial cells that line the endometrium.
  • Several microscopic subtypes

Categorized as Type I or Type II

Type I

  • Occurs in pre and peri menopauseal women.
  • Often found in white women
  • Low – grade, minimally invasive, estrogen-dependent, and good prognosis
  • 75-90% of cancers

Type II

  • Occurs in older women
  • More often found in black women
  • Not associated with estrogen
  • High grade, deep invasion, and a poorer prognosis
  • Tend to be more aggressive and greater chance for relapse or metastasis

 

Endometroid Adenocarcinoma

  • Cancer grows in endometrium – often the tissue or from Endometrial glands.
  • Well differentiated cells that usually won’t invade the myometrium.
  • Seen in patients with a history of endometrial hyperplasia.
  • If higher grade – less differentiation is seen.

Subtypes

  • Villoglandular
  • Secretory
  • Ciliated Cell

 

Serous Carcinoma

  • Is a Type II type
  • Makes up 5-10% of Endometrial Cancers
  • Is an aggressive form and often invades the myometrium and metastasizes.

 

Clear Cell Carcinoma

  • Is a Type II type
  • Makes up less than 5% of Endometrial Cancers
  • Is an aggressive form and has a poorer prognosis

 

Mucinous Carcinoma

  • Is a rare form of Endometial Cancer with less that 1%.
  • Is a Type I and has a good prognosis
  • Well-differentiated cells

 

Mixed or Undifferentiated Carcinoma

  • Can be a Type I or Type II cells
  • Can be mixed with Mullerian tumor
  • Often have no identifiable patterns
  • Poorer prognosis.

 

Others

  • Non-metastatic Squamous Cell Carcinoma
  • Transitional cell Carcinoma – rare
  • Others

 

Sarcoma

  • Are different than endometrial carcinomas
  • They are uncommon
  • Arise from the stromal.
  • Originate in non-glandular connective tissues of the endometrium

 

Metastasis

  • Endometrial cancers will move away from the site of initial invasion in some, but not all cases.
  • They can go to the Ovaries or Fallopian Tubes.
  • Often if cancer is in the upper part of the Uterus it will go to the ovaries and fallopian tubes
  • If in the lower part of the uterus it will often go to the Cervix.
  • First it spreads to the myometrium and then to the serosa.
  • If Lymphatic system is involved – lymph nodes and other locations can be seen.
  • Distant Metastases include the lungs, liver, brain, and bone.
  • Distant Metastases are spread by the blood.

 

Staging of the Cancer:

Stage IA:  – Tumor only found in endometrium
Stage IB:  – Less then half the myometrium involved
Stage IC:  – More than half the myometrium involved
Stage IIA:  – Endocervical involvement only
Stage IIB:  – Cervical stromal invasion
Stage IIIA:  – Tumor begins localized invasion or malignant peritoneal cytology
Stage IIIB:  – Metastasis to vagina wall
Stage IIIC:  – Metastasis to regional lymph nodes
Stage IVA:  – Metastasis to bladder or bowel
Stage IVB:  – Metastasis to distant organs

 

Treatment

  • Surgical hysterectomy
  • Cytologic examination
  • Chemotherapy
  • Hormone Therapy

Prognosis is 5+ yr survival of 80-85%

Greater the invasion the worst the prognosis

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