Atlas of pathophysiology, 2 Edition

Part II - Disorders

Genital Diseases

Endometrial Cancer

Also known as uterine cancer (cancer of the endometrium), endometrial cancer is the most common gynecologic cancer.

Age Alert

Uterine cancer usually affects postmenopausal women between ages 50 and 60; it's uncommon between ages 30 and 40 and extremely rare before age 30. Most premenopausal women who develop uterine cancer have a history of anovulatory menstrual cycles or other hormonal imbalance.

Causes

Primary cause unknown

Predisposing factors

·   Anovulation, abnormal uterine bleeding

·   History of atypical endometrial hyperplasia

·   Unopposed estrogen stimulation

·   Nulliparity

·   Polycystic ovarian syndrome

·   Familial tendency

·   Obesity, hypertension, diabetes

Pathophysiology

In most cases, uterine cancer is an adenocarcinoma that metastasizes late, usually from the endometrium to the cervix, ovaries, fallopian tubes, and other peritoneal structures. It may spread to distant organs, such as the lungs and the brain, through the blood or the lymphatic system. Lymph node involvement can also occur. Less common are adenoacanthoma, endometrial stromal sarcoma, lymphosarcoma, mixed mesodermal tumors (including carcinosarcoma), and leiomyosarcoma.

Signs and symptoms

·   Uterine enlargement

·   Persistent and unusual premenopausal bleeding

·   Any postmenopausal bleeding

·   Other signs or symptoms, such as pain and weight loss, don't appear until the cancer is well advanced

Diagnostic test results

·   Endometrial, cervical, or endocervical biopsy confirms the presence of cancer cells.

·   Fractional dilation and curettage identifies cancer when biopsy is negative.

·   Cervical biopsies and endocervical curettage pinpoint cervical involvement.

Treatment

·   Surgery—generally total abdominal hysterectomy, bilateral salpingo-oophorectomy, or possibly omentectomy with or without pelvic or para-aortic lymphadenectomy

·   Radiation therapy—intracavitary or external (or both):

§  if tumor is poorly differentiated or histology is unfavorable

§  if tumor has deeply invaded uterus or spread to extrauterine sites

§  may be curative in some patients

·   Hormonal therapy:

§  synthetic progesterones, such as medroxyprogesterone or megestrol, for recurrent disease

§  tamoxifen as a second-line treatment; 20% to 40% response rate

·   Chemotherapy—usually tried when other treatments have failed:

§  varying combinations of cisplatin, doxorubicin, etoposide, dactinomycin

§  no evidence that they're curative.

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PROGRESSION OF ENDOMETRIAL CANCER

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