ENDOMETRIAL CANCER

It accounts for 7%of all cancers in women. Peak incidance in age gr. 55 to 69 yrs.

PREDISPOSING FACTORS
1)Unsupervised administration of HRT with oestrogen alone during menopause.
2)women with oestrogen dominance suffering from endometrial hyperplasia.
3)familial predisposition
4)tamoxifen prescribed to women with breast ca.
5)OC pills have protective effect.6)obesity,hypertension,DM
7)Infertile women,those with fewer children nd subjects of polysystic ovarian disease.

PATHOLOGY

It may be localised or diffuse.It may appear as nodule,polyp or diffuse lesion involving entire uterine cavity.
Tumour involves uterine myometrium.
In advanced cases growth may spread beyond uterine body to involve cervix,vagina,nodes.
Histologically endometrial cancers are adeno carcinomas.

C/F=
1)it commonly manifest as menometrorrhagia in peri menopausal women
2)it can occure following unsupervised oestrogen replacement therapy
3)metastatic vaginal growth may be visible in advanced stage.
4)usg reveals thickened or hyper plastic endometrium or polyp

DDs
senile endometritis,tubercular endometritis,atypical endometrial hyperplasia nd lesion of lower genital tract also cause post menopausal bleeding.

MANAGEMENT oe endometrial ca.

SCREENING
routine screening of all asymptomatic women on HRT nd tamoxifen is reccomended
All women with history of post menopausal bleeding nd women on HRT need to be screened with pelvic sonography nd endometrial sampling
Diagnostic hysteroscopy in all suspicious cases

STAGING
staging laparotomy is done throuh lower abdominal incision,collect any peritoneal ascitic fluid for cytology.Complete abdominal exploration followed by total abdominal hysterectomy along with bilateral salpingo oophorectomy nd pelvic nd para aortic lymph node sampling.

FIGO STAGING OF ENDOMETRIAL CA.
Stage | =ca. Confined to corpus uteri.
  | A =tumour limited to endometrium
  | B =tumour involving half or less than half myometrial thickness.
  | C =involves more than half myometrial thickness.

  || =tumour involves cervix but doesnt extend beyond uterus
  || A =only endocervical gland involvement
  || B =cervical stromal invasion.

  ||| =local nd/or regional spread
  ||| A =tumour involves serosa,spread to adnexae.
  ||| B =presence of vaginal metastasis
  ||| C =node metastasis to pelvis nd para aortic lymph nodes
  |V =tumour wide spread
  |V A =involves bladder nd bowel mucosa
  |V B =distant metastis.


TREATMENT
1)Stage 0 (endometrial hyperplasia)=simple endometrial hyperplasia developes malignancy in 10 to 20% but atypical hyperplasia predispores to endometrial ca in 60 to 70%.
Abdominal hysterectomy with or without removal of ovaries in elderly women.
In younger women wishing to retain uterus nd is willing for lifelong follow up 30-40 mg medroxyprogesterone daily for 6 to 12 months.MIRENA IUCD also suited in these women.
TAH + BSO ,peritoneal washing,omental biopsy nd node sampling is basic treatment for all stages of disease.
2)Stage | A=no further treatment.
3)Stage | B=high risk of more than half myometrium involved.Add post operative pelvic irradiation of 4000 to 5000 cGY.
4) Stage || =pelvic irradiation followed by TAH + BSO.
Wertheim's hysterectomy is another alternative
5) Stage ||| =advanced disease not suitable for surgery
chemotherapy + radiotherapy
medroxyprogesterone 1-2 g wkly is palliative.
6) Stage |V =palliative radiotherapy,chemotherapy nd harmone therapy using large dose of progestogens.