婦產(chǎn)科子宮內(nèi)膜癌英文

婦產(chǎn)科子宮內(nèi)膜癌英文Endometriodcancer---ContentsIncidenceRiskfactorsClassificationSymptomsPathologyFIGOStagingDiagnosisTreatment2020/12/102WHOCancerReportGlobalcancerratescouldincreaseby50%to15millionby2020Endometrialcanceristhe4thmostcommoncancerinwomenNewDiagnosedcases:142,000Diedcaseseachyear:42,000incidence~2-3%Averageage:60s2020/12/103HistologicTypesEndometrialCancersEndometrioid(87%)Adenosquamous(4%)PapillarySerous(3%)ClearCell(2%)Mucinous(1%)Other(3%)2020/12/104

EndometrialCancer:TypeI/IITypeIEstrogenRelatedYoungerandheavierpatientsLowgradeBackgroundofHyperplasiaPerimenopausalExogenousestrogenFamilial/genetic(~15%)LynchIIsyndrome/HNPCCFamilialtrendTypeII(~10%)AggressiveHighgradeUnfavorableHistologyUnrelatedtoestrogenstimulationOccursinolder&thinnerwomen2020/12/105EndometrialCancer:RiskFactorsRiskFactorsRelativeRisk[X]

Obesity2-5

PCOS＞5Estrogenuse10-20Nulliparous3Infertility2-3Diabetes/Hypertension1.3-3Nulliparous3EarlyMenarche(<12y/o)1.5-2AtypicalHyperplasiaOC0.3-0.5From:WilliamsGynecology20092020/12/106EndometriumCarcinoma

2009Classification

StageCharacteristicStageI*TumorconfinedtothecorpusuteriIA*NoorlessthanhalfmyometrialinvasionIB*InvasionequaltoormorethanhalfofthemyometriumStageII*Tumorinvadescervicalstroma,butdoesnotextendbeyondtheuterus**StageIII*Localand/orregionalspreadofthetumorIIIA*Tumorinvadestheserosaofthecorpusuteriand/oradnexae#IIIB*Vaginaland/orparametrialinvolvement#IIIC*Metastasestopelvicand/orpara-aorticlymphnodes#.IIIC1*?PositivepelvicnodesIIIC2*?PositiveparaaorticlymphnodeswithorwithoutpositivepelviclymphnodesStageIV*Tumorinvadesbladderand/orbowelmucosa,and/ordistantmetastasesIVA*Tumorinvasionofbladderand/orbowelmucosaIVB*Distantmetastases,includingintra-abdominalmetastasesand/oringuinallymphnodes

2020/12/107StageI(73%)ConfinedtouterusStageII(11%)CervixinvolvedStageIII(13%)Uterineserosa,adnexae,positivecytology,vaginalmetastases,pelvic/aorticnodemetastasesStageIV(3%)Bladder,bowel,inguinalnode,distantmetastasisEndometrialCancer:FIGOSurgicalStage2020/12/108EndometrialCancerPrognosis:SurvivalbyStage:Stage%5yrsurvivalIA91IB88IC81IIA77IIB67IIIA60IIIB41IIIC32IVA20IVB5SurvivalbyGrade:Grade%5yrsurvival192287374Overall5YrSurvival84%StageandGradearethemostimportantprognosticfactorsAlteredoncogene/tumorsuppressorgeneexpressionisnowbeingevaluated(molecularstagingconcept)2020/12/109AggressiveHistologicSubtypes(Clear-cell,Serous)Increasingage(over65)VascularinvasionAneuploidyAlteredoncogene/tumorsuppressorgeneexpression(“molecularstaging”concept-p53,PTEN,microsatelliteinstability,MDR-1,HER2/neu,ER/PR,Ki67,PCNA,CD31,EGF-R,MMRgenes)RaceEndometrialCancer:PoorPrognosticFactors2020/12/1010MolecularGeneticsPTENmutations:32%Tumorsuppressorgene(chrom10)PhosphataseEarlyeventincarcinogenesisAssociatedwith:endometrioidhistologyearlystagefavorablesurvival2020/12/1011MolecularGeneticsp53tumorsuppressorgeneCellcycleandapoptosisregulationMostcommonlymutatedgeneinhumancancersOverexpression(markerformutation)Associatedwithpoorprognosisearlystage: 10%havep53mutationadvancedstage:50%havep53mutationnotfoundinhyperplasiaslateeventincarcinogenesis2020/12/1012GeneticSyndromes:HNPCC

HereditaryNon-PolyposisColonCancerLynchIISyndromeAutosomaldominantinheritanceMMR(mismatchrepair)mutationsGeneticinstabilityleadstoerror-proneDNAreplicationhMSH2(chrom2)hMLH1(chrom3)EarlyageofcolonCa:mean45.2yearsEndometrialCa:secondmostcommonmalignancy20%cumulativeincidencebyage70EarlierageofonsetthansporadiccasesOther:ovary(3.5-8fold),stomach,smallbowel,pancreas,biliarytract2020/12/1013Diagnosisofdisease:PatientAwareness*Morethan95%ofpatientswithEndometrialCancerreporthavingsymptomsPostmenapausalbleedingMenorrhagiaMetrorrhagiaBloodyDischargeEndometrialbiopsyisthemaindiagnostictoolperformedeitherintheofficeorviaD&CinOR2020/12/1014UterineCancer:

Diagnosis/ScreeningPatientSymptoms/Awareness*Cytology–NotasatisfactoryscreeningtestSonography–NotCosteffectiveHysteroscopy–NotCosteffectiveHistology–Secondarytosymptoms(notasascreeningtest)2020/12/1015EndometrialCancer:

TransvaginalUltrasoundScreening2020/12/1016EndometrialCancer:

TransvaginalUltrasoundScreening2020/12/1017EndometrialCancer:

TransvaginalUltrasoundScreening2020/12/1018Normalendometrialstripe:Postmenopausal 4-8mmPostmenopausalonHRT 4-10mmU/SforDetectionofanyuterinepathologySensitivity: 85-95%Specificity: 60-80%PPV2-10%NPV99%Summary:EndometrialCancer:

TransvaginalUltrasoundScreening2020/12/1019Hysteroscopy–NotsatisfactoryforscreeningtestStudiesoftheefficacyofhysteroscopyasadiagnostictoolvarywidelySensitivityreportedrangingfrom60-95%comparedtoD&CobtainedatthesametimeSpecificity50-99%2020/12/10202020/12/1021HysteroscopyandPositiveCytologyStudieshavebeenmixed:SomestudiessuggestanincreaseinpositiveperitonealcytologyseenatstaginglaparotomyinpatientswhohavehadhysteroscopyOtherstudieshavefailedtofindadifferenceinpositivecytologyinpatientsdiagnosedviahysteroscopyascomparedtoofficebiopsyorD&C2020/12/1022Hysteroscopy–NotsatisfactoryToomuchcostandrisktobeusedasascreeningtest.Usefulforevaluationofabnormaluterinebleedingwhereofficebiopsyisunrevealing.UseinconjunctionwithuterinecurettageUsefultoseeandresectpolypsandsmallsubmucousfibroidsUsefultoperformdirectedbiopsyofsmalllesions.2020/12/1023EndometrialCancer:

WhoNeedsanEndometrialBiopsyPostmenopausalbleedingPerimenopausalintermenstrualbleedingAbnormalbleedingwithhistoryofanovulationPostmenopausalwomenwithendometrialcellsonPapThickenedendometrialstripeviasonography2020/12/1024SamplingoftheEndometriumOfficebiopsyprocedures(Pipelle,Vabraaspirator,Karmancannula)willagreewithaD&CperformedintheOR~95%ofthetimeOfficebiopsyhasa16%falsenegativeratewhenthelesionisinapolyporthecancercoverslessthan50%oftheendometriumGuidoetal.JReprodMed.1995;40:553PatientswithpersistentPMBafternegativeofficebiopsyshouldhaveD&C(+/-hysteroscopy)D&CisthegoldstandardsamplingmethodpreoperativeD&Cwillagreewithdiagnosisathysterectomy94%ofthetime2020/12/10252020/12/10262020/12/10272020/12/1028TreatmentforEndometrialHyperplasiawithoutatypia:ProgestintherapycontinuousorcyclicalChildbearingage:ProgestindominantOCPs

orDepo-Provera150mgIMq3monthsorProvera10mgpo10days/monthandMayfollowwithovulationinductionafternormalbiopsyifpregnancydesiredPeriorPostmenopausal:Provera20mgpo10days/monthorDepo-Provera200mgIMq2monthsRepeatbiopsyin3-4months2020/12/1029TreatmentforAtypicalEndometrialHyperplasia:23%riskofprogressiontocarcinoma(over10years)ifuntreated.Standardtreatmentwhenchildbearingiscompleteistotalhysterectomy(abdominalorvaginal)Frozensectiontoruleoutcarcinoma(upto20%havecoexistingendometrialcancer)2020/12/1030TreatmentforAtypicalEndometrialHyperplasia:Conservativemedicaltherapycanbeattemptedinyoungerpatientswhorequestpreservationoffertility.D&CpriortoinitiationofmedicaltherapytoruleoutcarcinomaMegace40-80mg/day,Norethindroneacetate5mg/dayConservativetherapymayalsobeattemptedinyoungpatientswithearly,welldifferentiatedendometrialcarcinomas.Megace120-200mg/day,Norethindroneacetate5-10mg/day2020/12/1031Endometroidcarcinoma,GradingFIGO -Gr1-<5%solidtumor -Gr2-6%-50%solid -Gr3->50%solidtumorNUCLEARGRADESize,shape,stainingandchromatin,variability,prominentnucleoli.HighnucleargradeaddsonepointtoFIGOgrade2020/12/1032CA125ChestX-rayMammogramsColonEvaluationOthersasindicatedUterineCancer:Pre-opEvaluation2020/12/1033UterineCancer:Pre-opEvaluationTransvaginalU/SCTScanMRI2020/12/1034UterineCancer:Pre-opEvaluation2020/12/1035UterineCancer:SurgicalStagingPreoperativepreparationAntimicrobialprophylaxisDVTprophylaxisSteepTrendelenburgLonginstrumentsavailable2020/12/1036Availabilityoffrozensectiontodeterminetheextentofstagingprocedure.CapabilityofcompletesurgicalstagingCapabilityoftumorreductionifindicatedEndometrialCancer:Intra-operativeSurgicalPrincipals2020/12/1037EndometrialCancer:SurgicalApproachTAH-BSO/washingsonlyEndometrioid*Grades1and<50%myometrialinvasion*orGra