Endometrial Cancer.ppt

Endometrial Cancer Speaker : Shinenoam Chen Department of OBS/GYN. VGHKS Introduction Endometrial carcinoma is the most common gynecologic malignancy in the United States. Most cases are diagnosed at an early stage when surgery alone may be adequate for cure. Introduction Type I endometrial carcinoma is estrogen-related: 1. tends to be associated with endometrial hyperplasia. 2. low grade endometrioid tumor 3. risk factors such as obesity, nulliparity, endogenous or exogenous estrogen excess, diabetes mellitus, and hypertension. Introduction Type II endometrial carcinoma appears unrelated to estrogen : 1. older , multiparous. 2. poor prognostic cell types, such as papillary serous or clear cell tumors. ERT Estrogen Tx alone increases the risk for endometrial hyperplasia and carcinoma. Endometrial hyperplasia: 20-50% of women receiving unopposed estrogen in one year. RR: 3.1-15 (related to dose and duration) ERT Risk can be reduced by the concomitant administration of progestins. Endogenous estrogen Functional ovarian tumors Endogenous conversion of adrenal precursors into estrogen by adipose cells (estrone hypothesis) Higher circulating estrogen and androgen levels, and lower SHBG levels. Tamoxifen Competitive inhibitor of estrogen binding to estrogen receptors. adjuvant therapy in women with early stage breast cancer, as treatment for recurrent disease, and for reduction of breast cancer incidence in high-risk women. partial agonist activity, stimulating the endometrial lining. Tamoxifen 2-3fold increased risk of endometrial cancer. ACOG:the benefits outweigh the risks. ?Recommendations : 1.Annually Gyn exam. 2.Report vagina bleeding 3.Tx limited to 5 years 4. Hysterectomy if atypical hyperplasia. Obesity high levels of endogenous estrogen. Conversion of androstenedione to estrone and the aromatization of androgens to estradiol, both of which occur in peripheral adipose tissue. lower circulating levels of sex hormone binding glo