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58 Cards in this Set
- Front
- Back
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what are important epidemiological facts about endometrial carcinoma?
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most common cancer of female genital tract in developed countries, but worldwide most common is cervical cancer
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what are differentiating features of endometrial carcinoma compared to cervical carcinoma concerning age?
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endometrial carcinoma is "carcinoma of age"
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what are differentiating features of endometrial carcinoma compared to cervical carcinoma concerning hormones?
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endometrial carcinoma (type I) is hormone dependent
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what are differentiating features of endometrial carcinoma compared to cervical carcinoma concerning screening?
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endometrial carcinoma can be detected in early stages due to early symptoms (bleeding!)
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what hormone is endometrium dependent on for proliferation?
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estrogens
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what hormone limits endometrium proliferation?
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gestagens, eg progesteron induce secretory transformation
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what is the broad classification of endometrial carcinoma
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type I and type II
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what is the distribution between type I and type II endometrial carcinoma?
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80% type I
20% type II |
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what are the histological types of type I endometrial carcinoma?
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endometrioid adenocarcinoma
sometimes with adenosquamous parts (in 20%) |
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what is the precursor in type I endometrial carcinoma?
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malignant transformation of endometrial HYPERPLASIA with atypias assisted by hyperestrogenism
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what is the precursor in type II endometrial carcinoma?
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malignant transformation of INTRAEPITHELIAL CARCINOMA in otherwise atrophied endometrial tissue
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what are the tumorbiologic features of type II endometrial carcinoma?
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hormone-independent with scant expression of estrogen and progesteron receptors
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what are the tumorbiologic features of type I endometrial carcinoma?
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most hormone-dependent with rich expression of estrogen and progesteron receptors
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what role do risk factors play in type I endometrial carcinoma?
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incidence correlates with various risk factors, in contrast to type II endometrial carcinoma
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what role do risk factors play in type II endometrial carcinoma?
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often without risk factors, especially without adipositas
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which carcinomas are associated with endometrial carcinoma?
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mamma, ovarian and colon carcinoma
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which carcinomas are NOT associated with endometrial carcinoma?
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cervical and vulvar carcinoma
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what are risk factors for type I endometrial carcinoma?
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adipositas through extraglandular aromatisation
age early menarche, late menopause hormone substitution therapy certain SERM (eg tamoxifen) through partial estrogen-agonism polycystic ovaries through gestagen insufficiency and thus relative hyperestrogenism |
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what are the histological subtypes of type II endometrial carcinoma?
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serous-papillary adenocarcinoma
clear cell adenocarcinoma |
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in what age group does endometrial carcinoma occur?
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mainly in postmenopausal women
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at what age range is the peak incidence of type I endometrial carcinoma?
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55-65 years
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at what age range is the peak incidence of type II endometrial carcinoma?
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65-75 years
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what are disorders associated with but not a proven risk factor for type I endometrial carcinoma?
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diabetes and hypertonia
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what is the grading system for type I endometrial carcinoma?
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grade I
well-differentiated adenocarcinoma < 5% solid growth grade II moderately differentiated adenocarcinoma < 50% solid growth grade III poorly differentiated adenocarcinoma > 50% solid growth |
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what is the typical setting in type I endometrial carcinoma?
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endometrial HYPERPLASIA
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what is the typical setting in type II endometrial carcinoma?
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endometrial ATROPHY
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what is the staging system for endometrial carcinoma (and malignant mixed müllerian tumors)?
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stage I
confined to corpus uteri stage II involves cervix stage III extends outside uterus but not outside true pelvis stage IV extends outside true pelvis or involves adjacent organ (ie bladder or rectum) |
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what is the most common origin of endometrial carcinoma?
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fundus uteri
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what are the growth patterns of endometrial carcinoma?
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exophytic into lumen
or invasive into myometrium |
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what is the per continuitatem spread of endometrial carcinoma?
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cervix, with parametrium in further course
vagina anterior wall in upper third often suburethral intracanalicular via tuba uterina into abdominal cavity --> peritoneal metastasis |
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what is the lymphogenous spread of endometrial carcinoma?
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pelvin and paraaortal
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what is the hematogenous spread of endometrial carcinoma?
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lung, liver
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what are the clinical symptoms of endometrial carcinoma?
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postmenopausal bleeding and irregular bleeding (metrorrhagia)
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what are the initial diagnostic steps for endometrial carcinoma?
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hysteroscopy with fractionated curettage
or vacuum aspiration |
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what is fractionated curettage?
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sequential and separate asservation of tissue
tissue asservation from cervical canal and entire cavum uteri |
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what does the preoperative staging consist of?
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exclusion of distant metastasis
thorax rx upper abdominal sonography to exlude liver metastases |
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what are malignant causes in the differential diagnosis of vaginal bleeding?
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tumors of cervix, uterus sarcoma, carcinoma of vulva/ vagina/ ovary or tube
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what are benign causes in the differential diagnosis of vaginal bleeding?
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polyps (mainly corpus polyps), submucosal myoma, bleeding in atrophied endometrium
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what percentage of patients with endometrial carcinoma have stage I disease at diagnosis?
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75%
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what percentage of patients have stage II-IV disease at diagnosis?
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stage II and III, 10% each
stage IV 5% |
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what is the 5 year survival for stage I disease in endometrial carcinoma?
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>85%
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what are the salient prognostic factors in endometrial carcinoma?
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depth of invasion and extent of tumor expansion most important (thus staging criteria)
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what is the staging system for endometrial carcinoma primarily based on?
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depth of invasion and extent of tumor expansion
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what are the therapy principles for atypical endometrial hyperplasia?
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desire for children -> gestagen therapy
no desire for children or postmenopausal -> hysterectomy |
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in what percentage can endometrial carcinoma be found when atypical endometrial hyperplasia had been diagnosed?
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40% !
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what are the therapy principles for endometrial carcinoma?
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peritoneal cytology
hysterectomy plus bilateral adnexectomy = bilateral salpingo-oophorectomy |
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when is lympadenectomy not performed in type I endometrial carcinoma?
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lower grade (G1 or G2), invasion of myometrium <50% (stage IA)
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what is the importance of radiotherapy in endometrial carcinoma?
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not performed routinely, as overall survival is not improved
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what is the aim of adjuvant local radiotherapy?
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decrease of local relapse
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when is adjuvant chemotherapy indicated in endometrial carcinoma?
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when high risk of distant metastasis, ie multiple regional lymph nodes affected or peritoneal metastasis
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what are chemotherapy substance classes commonly used in endometrial carcinoma?
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platin, anthracyclines, taxanes
mnemonic: PAT Pat on the back |
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what are commonly used chemotherapy combinations used for endometrial carcinoma?
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platin/ taxan (-taxel)
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what is the other tumor class in the differential diagosis of endometrial carcinoma?
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uterus SARCOMA
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what are the histologic subtypes of uterus sarcoma
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malignant mixed müllerian tumors (MMMT), formerly known as carcinosarcoma = adenocarcinoma + stroma sarcoma
leiomyosarcoma endometrial stroma sarcoma |
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what is the primary localisation of carcinomasarcoma (MMMT)?
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corpus uteri, not fundus as in
endometrial carcinoma |
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what is the typical way of metastasis in leiomyosarcoma?
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hematogenous
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what percentage of endometrial carcinoma occur in women < 40 years
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5%
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what is the incidence of endometrial cancer?
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20/100'000
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