Endometrial Cancer

Endometrial Cancer

Endometrial cancer is the most common gynecological cancer in the US. It’s called a disease of peri-menopausal women, with the peak ages around age 50-70. If it’s detected early, the prognosis for survival is good. 

Most endometrial cancers are estrogen-related, but there are some that are non-estrogen-related also. 

The risk factors are the markers of hyper-estrogenism.

·         Obesity

o        Post-menopausal ovaries produce androsteronedione, a weak androgen.

o        In obese women, androsteronedione is converted to estrogen, leading to unopposed estrogen action in the endometrium.

·         Infertility history

·         Early menarche

·         Late menopause

·         Polycystic ovaries

o        Women are unable to ovulate due to inadequate hormone production.

·         Estrogen medications without progesterone

Other risk factors include:

·         Radiation

o        This causes malignancies.

·         Diabetes & HTN

o        They still don’t know if DM and HTN are real risk factors for endometrial cancer or if they’re co-morbidities in post-menopausal women with cancer.

·         Obesity

·         Previous history of breast/ovarian cancer

Signs of possible endometrial cancer

·         Post-menopausal bleeding

·         Other abnormal bleeding (between menses or post-coital)
 

Diagnosis of endometrial cancer can only been done by tissue sampling. This is the gold standard. Ultrasound images (sonograms) can also be used as an additional study. Endometrial cancers are rarely detected via Pap smears, and so they are not very useful for its diagnosis. 

Endometrial cancer can invade into the myometrium. 

On a histologic sample, the tissue looks like it’s composed of back-to-back endometrial glands without any stroma present. Cryptoforming glands, which are glands forming within glands, can also be seen. 

There are 2 types of endometrial cancers.

1.       Type I

a.      Estrogen-related

b.       Majority of endometrial cancers

c.       Younger patients

                                                               i.      Pre/peri-menopausal

d.       More likely to have adjacent endometrial hyperplasia due to hyper-estrogenism.

2.       Type II

a.      Not estrogen-related

b.       20% of endometrial cancers

c.       More prevalent in African-American women

d.       Worse grading and cellular behavior than Type I

e.       Two types, which behave much like ovarian cancer

                                                              i.      Papillary serous carcinoma

                                                            ii.      Clear cell carcinoma

The prognosis for endometrial cancer usually deals with Type I endometrial cancer.

·         Grading is determined by how it looks under the microscope. In other cancers, it is based on what the nuclei look like. However, in endometrial cancer, grading is based on the percentage of solid endometrial tissue present. The more glands there are, the worse the grading.

·         The depth of invasion into the myometrium also determines prognosis.

·         A combination of surgery and pathology is necessary for diagnosis.

·         The 5-year survival rate for Stage 1 is >85%. For Stage II, it’s about 10%.

Here is a simplified method of staging, also known as typing. She told us not to memorize it but to realize that in stage I, the cancer is confined to the organ of origin. For stage IV, the cancer is spread everywhere. However, I’m not sure if you should memorize it, considering the course directors make up the exam questions.

·         Stage I – Corpus

·         Stage II – Corpus/Cervix

·         Stage III – Outside uterus in true pelvis

·         Stage IV – Outside true pelvis; bladder/rectal mucosa

Endometrial cancer metastasizes via hematogenous spread. Therefore, it’s spread everywhere. (Unlike cervical cancer, which metastasizes via lymphatic spread, and stays localized in the pelvic cavity.)

·         Ovary

·         Lung

·         Liver

·         Brain

·         Etc.

Back to the Reproductive System Index