Citizendia

Endometrial cancer
Classification and external resources
An endometrial adenocarcinoma invading the uterine muscle
ICD-10 C54.1
ICD-9 182
OMIM 608089
DiseasesDB 4252
MedlinePlus 000910
eMedicine med/674  radio/253

Endometrial cancer refers to several types of malignancy which arise from the endometrium, or lining of the uterus. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Cancer (medical term Malignant Neoplasm) is a class of Diseases in which a group of cells display uncontrolled The endometrium is the inner membrane of the Mammalian Uterus. The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year in the U. S. The most common subtype, endometrioid adenocarcinoma, typically occurs within a few decades of menopause, is associated with excessive estrogen exposure, often develops in the setting of endometrial hyperplasia, and presents most often with vaginal bleeding. Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, Endometrial hyperplasia is a condition of excessive proliferation of the cells of the Endometrium, or inner lining of the Uterus. Vaginal bleeding refers to bleeding in females that is either a physiologic response during the non-conceptional Menstrual cycle or caused by hormonal or organic problems of Endometrial carcinoma is the third most common cause of gynecologic cancer death (behind ovarian and cervical cancer). Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial Cervical cancer is Malignant Cancer of the Cervix uteri or cervical area A total abdominal hysterectomy (surgical removal of the uterus) with bilateral salpingo-oophorectomy is the most common therapeutic approach. A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist.

Endometrial cancer may sometimes be referred to as uterine cancer. The term uterine cancer may refer to any of several different types of Cancer which occur in the Uterus, namely Uterine sarcomas However, different cancers may develop not only from the endometrium itself but also from other tissues of the uterus, including cervical cancer, sarcoma of the myometrium, and trophoblastic disease. Cervical cancer is Malignant Cancer of the Cervix uteri or cervical area A uterine sarcoma is a malignant tumor that arises from the Smooth muscle or Connective tissue of the Uterus. The myometrium is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue Gestational trophoblastic disease is any type of abnormal proliferation of Trophoblasts during Pregnancy.

Contents

Classification

Most endometrial cancers are carcinomas (usually adenocarcinomas), meaning that they originate from the single layer of epithelial cells which line the endometrium and form the endometrial glands. A carcinoma is any Malignant Cancer that arises from epithelial cells. Adenocarcinoma is a cancer that originates in Glandular tissue In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body There are many microscopic subtypes of endometrial carcinoma, including the common endometrioid type, in which the cancer cells grow in patterns reminiscent of normal endometrium, and the far more aggressive papillary serous and clear cell endometrial carcinomas. Histopathology (from the Greek histos (tissue and pathos (suffering refers to the microscopic examination of tissue in order to study the manifestations Some authorities have proposed that endometrial carcinomas be classified into two pathogenetic groups:[1]

In contrast to endometrial carcinomas, the uncommon endometrial stromal sarcomas are cancers which originate in the non-glandular connective tissue of the endometrium. In Pathology, grading is a measure of the progress of Tumors and other Neoplasms Some pathology grading systems apply only to Malignant neoplasms A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, Muscle, and Nervous tissue) Uterine carcinosarcoma,formerly called Malignant mixed müllerian tumor, is a rare uterine cancer which contains cancerous cells of both glandular and sarcomatous appearance - in this case, the cell of origin is unknown. Carcinosarcoma is a Malignant tumor that is a mixture of Carcinoma ( Cancer of Epithelial tissue, which is Skin and tissue that lines A sarcoma (from the Greek 'sarx' meaning "flesh" is a Cancer of the connective or supportive tissue ( Bone, Cartilage, Fat [2]

Endometrial stromal sarcoma

Uterine carcinosarcoma

Signs and symptoms

in women older than 40: extremely long, heavy, or frequent episodes of bleeding (may indicate premalignant changes)

Causes

Most women with endometrial cancer have a history of unopposed and increased levels of estrogen. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, One of estrogen's normal functions is to stimulate the buildup of the endometrial lining of the uterus. The endometrium is the inner membrane of the Mammalian Uterus. Excess estrogen activity, especially in the setting of insufficient progesterone, may produce endometrial hyperplasia, which can be a precursor for cancer. Progesterone is a C-21 Steroid Hormone involved in the Female Menstrual cycle, Pregnancy (supports Gestation Endometrial hyperplasia is a condition of excessive proliferation of the cells of the Endometrium, or inner lining of the Uterus.

Increased estrogen may be due to:

The incidence of endometrial cancer in women in the U.S. is 1 % to 2 %. The United States of America —commonly referred to as the The incidence peaks between the ages of 60 and 70 years, but 2 % to 5 % of cases may occur before the age of 40 years. Increased risk of developing endometrial cancer has been noted in women with increased levels of natural estrogen.

Associated conditions include the following:

Increased risk is also associated with the following:

Women who have a history of endometrial polyps or other benign growths of the uterine lining, postmenopausal women who use estrogen-replacement therapy (specifically if not given in conjunction with periodic progestin) and those with diabetes are also at increased risk. Obesity is a condition in which excess Body fat has accumulated to such an extent that health may be negatively affected Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis Female infertility|Male infertility Infertility primarily refers to the biological inability of a Man or a Woman to contribute to conception. Menarche (American English məˈnɑrki British English mɛˈnɑːki is the first menstrual period, or first menstrual bleeding in the females of Human beings Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan An endometrial polyp or uterine polyp is a big lump in the inner lining of the uterus Hormone replacement therapy may refer to Hormone replacement therapy (menopause Hormone replacement therapy (female-to-male A progestin is a synthetic progestagen that has progestinic effects similar to Progesterone. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc

Tamoxifen, a drug used to treat breast cancer, can also increase the risk of developing endometrial cancer. Tamoxifen is an orally active Selective estrogen receptor modulator (SERM that is used in the treatment of Breast cancer and is currently the world's largest Breast cancer is a Cancer that starts in the cells of the Breast in women and men

The same risk factors predisposes women to endometrial hyperplasia, which is a precursor lesion for endometrial carcinoma. Hyperplasia (or "hypergenesis" is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen in e An atypical complex hyperplasia carries a 30% risk of developing endometrial carcinoma, while a typical simple hyperplasia only carries a 2-3% risk.

Alcohol as a risk factor

"Thirteen studies to date have reported on the relationship between endometrial cancer and alcohol consumption. Only two of these studies have reported that endometrial cancer incidence is associated with consumption of alcohol; all the others have reported either no definite association, or an inverse association. " (Six studies showed an inverse association; that is, drinking was associated with a lower risk of endometrial cancer) "…if such an inverse association exists, it appears to be more pronounced in younger, or premenopausal, women. "[3] "Our results suggest that only alcohol consumption equivalent to 2 or more drinks per day increases risk of endometrial cancer in postmenopausal women. "[4]

Diagnosis

Clinical evaluation

Routine screening of asymptomatic women is not indicated, since the disease is highly curable in its early stages. Results from a pelvic examination are frequently normal, especially in the early stages of disease. A pelvic examination, also pelvic exam, is a Physical examination of the Female pelvic organs Broadly it can be divided into Changes in the size, shape or consistency of the uterus and/or its surrounding, supporting structures may exist when the disease is more advanced.

Diagnostic test study of S-p53 Ab and agreement study for high-risk endometrial cancer Kappa: 0. 70 Sensitivity (%): 64 Specificity(%): 96 PPV: 78 NPV: 92

Pathology

Endometrial adenocarcinoma
Endometrial adenocarcinoma

The histopathology of endometrial cancers is highly diverse. The most common finding is a well-differentiated endometrioid adenocarcinoma, which is composed of numerous, small, crowded glands with varying degrees of nuclear atypia, mitotic activity, and stratification. This often appears on a background of endometrial hyperplasia. Frank adenocarcinoma may be distinguished from atypical hyperplasia by the finding of clear stromal invasion, or "back-to-back" glands which represent nondestructive replacement of the endometrial stroma by the cancer. With progression of the disease, the myometrium is infiltrated. [2]

Further evaluation

Patients with newly-diagnosed endometrial cancer do not routinely undergo imaging studies, such as CT scans to evaluate for extent of disease, since this is of low yield. Computed tomography (CT is a Medical imaging method employing Tomography. Preoperative evaluation should include a complete medical history and physical examination, pelvic examination and rectal examination with stool guaiac test, chest X-ray, complete blood count, and blood chemistry tests, including liver function tests. stool guaiac test detects the presence of Fecal occult blood. Colonoscopy is recommended if the stool is guaiac positive or the woman has symptoms, due to the etiologic factors common to both endometrial cancer and colon cancer. Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and The tumor marker CA-125 is sometimes checked, since this can predict advanced stage disease. CA-125, also known as CA125 is an abbreviation for cancer Antigen 125 [6]

Staging

Endometrial carcinoma is surgically staged using the FIGO cancer staging system. The International Federation of Gynecology and Obstetrics, usually just FIGO as the acronym of its French name Fédération Internationale de Gynécologie et d'Obstétrique The stage of a cancer is a descriptor (usually numbers I to IV of how much the Cancer has spread

Treatment

The primary treatment is surgical. The myometrium is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue Surgical treatment should consist of, at least, cytologic sampling of the peritoneal fluid, abdominal exploration, palpation and biopsy of suspicious lymph nodes, abdominal hysterectomy, and removal of both ovaries (bilateral salpingo-oophorectomy). A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist. "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is sometimes performed for tumors that have high risk features, such as pathologic grade 3 serous or clear-cell tumors, invasion of more than 1/2 the myometrium, or extension to the cervix or adnexa. Sometimes, removal of the omentum is also performed.

Abdominal hysterectomy is recommended over vaginal hysterectomy because it affords the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of cancer. A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist. A hysterectomy (from Greek hystera "womb" is the surgical removal of the Uterus, usually performed by a gynecologist.

Women with stage 1 disease who are at increased risk for recurrence and those with stage 2 disease are often offered surgery in combination with radiation therapy[7]. Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Chemotherapy may be considered in some cases, especially for those with stage 3 and 4 disease. Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. hormonal therapy with progestins and antiestrogens has been used for the treatment of endometrial stromal sarcomas. Hormonal therapy is one of the major modalities of medical treatment for cancer others being cytotoxic chemotherapy and Targeted therapy (biotherapeutics [8]


Complications of treatment

Support groups

The stress of illness can often be helped by joining a support group where members share common experiences and problems. In a support group, members provide each other with various types of help usually nonprofessional and nonmaterial for a particular shared usually burdensome characteristic

Prognosis

Because endometrial cancer is usually diagnosed in the early stages (70 % to 75 % of cases are in stage 1 at diagnosis; 10 % to 15 % of cases are in stage 2; 10 % to 15 % of cases are in stage 3 or 4), there is a better probable outcome associated with it than with other types of gynecological cancers such as cervical or ovarian cancer. Gynecologic oncology is a specialized field of medicine that focuses only on cancers of the female reproductive system notably Ovarian cancer, Cervical cancer, Cervical cancer is Malignant Cancer of the Cervix uteri or cervical area Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial While endometrial cancers are 40% more common in Caucasian women, an African American woman who is diagnosed with uterine cancer is twice as likely to die, possibly due to the higher frequency of aggressive subtypes in that population.

Survival rates

The 5-year survival rate for endometrial cancer following appropriate treatment is:

Epidemiology

Endometrial cancer occurs in both premenopausal (25%) and postmenopausal women (75%). The most commonly affected age group is between 50 and 59 years of age. Most tumors are caught early and thus prognosis is good and morbidity is declining.

References

  1. ^ Bokhman JV (1983). "Two pathogenetic types of endometrial carcinoma". Gynecol. Oncol. 15 (1): 10–7. PMID 6822361.  
  2. ^ a b Richard Cote, Saul Suster, Lawrence Weiss, Noel Weidner (Editor). Modern Surgical Pathology (2 Volume Set). London: W B Saunders. ISBN 0-7216-7253-1.  
  3. ^ UK Department of Health Review of Alcohol: Association with Endometrial Cancer p8
  4. ^ Veronica Wendy Setiawan, Kristine R. Monroe, Marc T. Goodman, Laurence N. Kolonel, Malcolm C. Pike, Brian E. Henderson Alcohol consumption and endometrial cancer risk: The multiethnic cohort International Journal of Cancer Volume 122, Issue 3 , Pages 634 - 638 10. 1002/ijc. 23072
  5. ^ Am J Obstet Gynecol. 2007 Nov;197(5):505. e1-7 PMID: 17980190
  6. ^ Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000;182:1328-34. PMID 10871446.
  7. ^ Brachytherapy. 2008 Mar 19 PMID: 18358790
  8. ^ [1] American Cancer Society - Uterine Sarcomas - Hormonal Therapy (accessed 5-25-07)

External links

© 2009 citizendia.org; parts available under the terms of GNU Free Documentation License, from http://en.wikipedia.org