*,*,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Endometrial Cancer,OB/GYN Hospital,Fudan University,Xin LU,MD,Ph.D.,1,Endometrial CancerOB/GYN Hospi,Endometriod cancer-Contents,Incidence,Risk factors,Classification,Symptoms,Pathology,FIGO Staging,Diagnosis,Treatment,2,Endometriod cancer-ContentsI,WHO Cancer Report,Global cancer rates could increase by 50%to 15 million by 2020,Endometrial cancer is the 4,th,most common cancer in women,New Diagnosed cases:142,000,Died cases each year:42,000,incidence 2-3%,Average age:60s,3,WHO Cancer ReportGlobal cancer,Histologic Types,Endometrial Cancers,Endometrioid(87%),Adenosquamous(4%),Papillary Serous (3%),Clear Cell (2%),Mucinous(1%),Other(3%),4,Histologic TypesEndometrial Ca,Endometrial Cancer:Type I/II,Type I,Estrogen Related,Younger and heavier patients,Low grade,Background of Hyperplasia,Perimenopausal,Exogenous estrogen,Familial/genetic(15%),Lynch II syndrome/HNPCC,Familial trend,Type II,(10%),Aggressive,High grade,Unfavorable Histology,Unrelated to estrogen stimulation,Occurs in older&thinner women,5,Endometrial Cancer:Type I/IIT,Endometrial Cancer:Risk Factors,Risk Factors,Relative Risk X,Obesity,2-5,PCOS,5,Estrogen use,10-20,Nulliparous,3,Infertility,2-3,Diabetes/Hypertension,1.3-3,Nulliparous,3,Early Menarche(12 y/o),1.5-2,Atypical Hyperplasia OC,0.3-0.5,From:Williams Gynecology 2009,6,Endometrial Cancer:Risk Fact,Endometrium Carcinoma2009 Classification,Stage Characteristic,Stage I*Tumor confined to the corpus uteri,IA*No or less than half myometrial invasion,IB*Invasion equal to or more than half of the myometrium,Stage II*Tumor invades cervical stroma,but does not extend beyond the uterus*,Stage III*Local and/or regional spread of the tumor,IIIA*Tumor invades the serosa of the corpus uteri and/or adnexae#,IIIB*Vaginal and/or parametrial involvement#,IIIC*Metastases to pelvic and/or para-aortic lymph nodes#.,IIIC1*,Positive pelvic nodes,IIIC2*,Positive paraaortic lymphnodes with or without positive pelvic,lymph nodes,Stage IV*Tumor invades bladder and/or bowel mucosa,and/or distant metastases,IVA*Tumor invasion of bladder and/or bowel mucosa,IVB*Distant metastases,including intra-abdominal metastases and/or inguinal,lymph nodes,7,Endometrium Carcinoma2009 Cla,Stage I,(73%),Confined to uterus,Stage II,(11%),Cervix involved,Stage III,(13%),Uterine serosa,adnexae,positive cytology,vaginal metastases,pelvic/aortic node metastases,Stage IV,(3%),Bladder,bowel,inguinal node,distant metastasis,Endometrial Cancer:FIGO Surgical Stage,8,Stage IConfined to uterusStage,Endometrial Cancer Prognosis:,Survival by Stage:,Stage,%5yr survival,IA,91,IB,88,IC,81,IIA,77,IIB,67,IIIA,60,IIIB,41,IIIC,32,IVA,20,IVB,5,Survival by Grade:,Grade,%5yr survival,1,92,2,87,3,74,Overall 5Yr Survival 84%,Stage and Grade are the most important prognostic factors,Altered oncogene/tumor suppressor gene expression is now being evaluated(molecular staging concept),9,Endometrial Cancer Prognosis:S,Aggressive Histologic Subtypes(Clear-cell,Serous),Increasing age(over 65),Vascular invasion,Aneuploidy,Altered oncogene/tumor suppressor gene expression(“molecular staging”concept-p53,PTEN,microsatellite instability,MDR-1,HER2/neu,ER/PR,Ki 67,PCNA,CD 31,EGF-R,MMR genes),Race?,Endometrial Cancer:Poor Prognostic Factors,10,Aggressive Histologic Subtypes,Molecular Genetics,PTEN mutations:32%,Tumor suppressor gene(chrom 10),Phosphatase,Early event in carcinogenesis,Associated with:,endometrioid histology,early stage,favorable survival,11,Molecular GeneticsPTEN mutatio,Molecular Genetics,p53 tumor suppressor gene,Cell cycle and apoptosis regulation,Most commonly mutated gene in human cancers,Overexpression(marker for mutation),Associated with poor prognosis,early stage:10%have p53 mutation,advanced stage:50%have p53 mutation,not found in hyperplasias,late event in carcinogenesis,12,Molecular Geneticsp53 tumor su,Genetic Syndromes:HNPCC,Hereditary Non-Polyposis Colon Cancer,Lynch II Syndrome,Autosomal dominant inheritance,MMR(mismatch repair)mutations,Genetic instability leads to error-prone DNA replication,hMSH2(chrom 2),hMLH1(chrom 3),Early age of colon Ca:mean 45.2 years,Endometrial Ca:second most common malignancy,20%cumulative incidence by age 70,Earlier age of onset than sporadic cases,Other:ovary(3.5-8 fold),stomach,small bowel,pancreas,biliary tract,13,Genetic Syndromes:HNPCCHere,Diagnosis of disease:Patient Awareness*,More than 95%of patients with Endometrial Cancer report having symptoms,Postmenapausal bleeding,Menorrhagia,Metrorrhagia,Bloody Discharge,Endometrial biopsy is the main diagnostic tool,performed either in the office or via D&C in OR,14,Diagnosis of disease:Patient,Uterine Cancer:Diagnosis/Screening,Patient Symptoms/Awareness*,Cytology Not a satisfactory screening test,Sonography Not Cost effective,Hysteroscopy Not Cost effective,Histology Secondary to symptoms(not as a screening test),15,Uterine Cancer:Diagnosis/Scre,