UTERINE CANCER/ENDOMETRIAL

CANCER

MR. POORAN SINGH BHATI

ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
 INTRODUCTION
• Uterine cancer or endometrial cancer is the most common gynecological cancer.
• It develops in the body of the uterus/womb which is a hallow organ located in the
lower abdomen.
DEFINITION-
• Endometrial cancer is a type of cancer that begins in the uterus.
• Endometrial cancer begins in the layer of cells that form the lining (Endometrial)
of the uterus.
• Most endometrial cancers are adenocarcinoma (Cancers that begin in cells that
make & release mucus & other fluids).
• Endometrial cancer originates in the inner lining of the uterus accounts for about
90% of uterine cancer.
• Uterine sarcoma originates in an outer layer of muscle tissue (Myometrium) & it
accounts for less than 10% of cases.
 INCIDENCE
• 4th most common cancer in women in U.S. behind breast, lung & colon cancer.
• 11th leading cause of female mortality from cancer.
• 97% arises from the endometrium & 3% arises from the mesenchymal
components.
• 75% of uterine cancers occur in post menopausal women.
• 2-3% of women develop it in lifetime.
• Mean age is 60 year.
• Uncommon before the age of 40 year.
 ETIOLOGY & RISK FACTORS
• The exact cause of uterine cancer is unknown.
• Chronic exposure to estrogen.
• Endometrial hyperplasia.
• Obesity & related conditions.
• Tamoxifen
• A high fat diet.
• Diabetes, HTN associated with endometrial cancer.
• Other Risk Factors-
• Age (More common after age 50).
• Family history of uterine cancer.
• Personal history of breast, colorectal or ovarian cancer.
• Nulliparity.
• Late menopause.
• Early menarche.
 STAGES OF CANCER
• Stage-0- Atypical hyperplasia.
• Stage-I- Tumor limited to the uterus.
• Stage-Ia- Limited to the endometrium.
• Stage-Ib- Invasion < half of the myometrium.
• Stage-Ic- Invasion > half of the myometrium.
• Stage-II- Extension to the cervix.
• Stage-IIa- Involves endo-cervical gland only.
• Stage-IIb- Invasion of cervical stroma.
• Stage-III- Spread to adjacent to uterus.
• Stage-IIIa- Invades serosa.
• Stage-IIIb- Vaginal invasion.
• Stage-IIIc- Invasion of pelvic or para aortic lymph nodes.
• Stage-IV- Spread further from uterus.
• Stage-IVa- Involves bladder or rectum.
 CLINICAL MANIFESTATION
• Early uterine cancer usually asymptomatic.
• Abnormal vaginal bleeding most common symptoms.
• Any bleeding after menopause.
• Prolonged periods or bleeding between periods.
• An abnormal & non bloody vaginal discharge.
• Painful or difficult urination.
• Pelvic pain.
• Pain during intercourse.
• Advance uterine cancer may cause weight loss, loss of appetite & change in
bladder & bowel habits.
• Pyometria/ Hematometria
 DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• PAP Smear
• Endometrial biopsy
• Hysteroscopy
• Trans-vaginal ultrasound
• Fraction dilation & curettage (use in cases of cervical stenosis, patient intolerance
to exam, recurrent bleeding after biopsy).
• CT Scan
• MRI Scan
• PET Scan
• Blood examination- CBC, LFT, Ca-125 (use in advance disease)
 MANAGEMENT
RADIATION MANAGEMENT-
• Some women with stage- I, II or III uterine cancer need both radiation therapy &
surgery.
• Radiation therapy is most often given after surgery to destroy any cells remaining
in the area but rarely given before surgery to shrink the tumor.
• It should be given external or internal radiation.
CHEMOTHERAPY-
• Women with stage-III or stage-IV endometrial cancer will be offered
chemotherapy.
Example- Cisplatin, Carboplatin, Decorubicin, Cyclophosphamide
 MANAGEMENT
SURGERY-
• Most doctors recommend either the surgical removal of the uterus alone
(Hysterectomy)
• Hysterectomy with Bilateral Salpingo-oophorectomy
• Lymph nodes in the area should also be removed during surgery.
HORMONAL THERAPY-
• Hormonal therapy for uterine cancer after involves the hormone progesterone
given in pills form, it may stop it from growing.
• Another therapy option is Gonadotropin Releasing hormone agonist (Lupron,
zoladex) these drugs can lower estrogen levels in premenopausal women.