妇产科学-Endometrial Cancer.ppt

Endometrial cancerZhuzhiling One of the commonest gynecological cancers it occurs most often in postmenopausal women（up to 80％of cases）with less than 5％ diagnosed under 40 years of age． Risk Factors The actual cause of this cancer is unknown． Estrogen given estrogen alone as postmenopausal hormone replacement therapy Estrogen secreting tumors of the ovary are associated with an increased incidence of endometrial carcinoma． There can be no doubt that oestrogen can alter the behaviour of this tumour but there is still a question about oestrogen as a primary causal agent． Approximately 75％of cases of endometrial cancer occur in the postmenopausal period when estrogen values are low and progesterone is absent．Nulliparity and PCO syndrome（with defective progesterone synthesis）carry an increased risk．  Endometrial hyperplasia often develops before endometrial cancer Patients with hyperplasia are at higher risk for developing cancer of the endometrium Patients with hyperplasia should be treated with progestins or hysterectomy if atypical cells are associated with the hyperplasic cells Endometrial Cancer Symptoms – Bleeding after menopause is most common symptom – Women who develop endometrial cancer before menopause will have abnormal menstrual bleeding Postmenopausal Bleeding Most postmenopausal bleeding is from benign conditions most common benign causes are endometrial polyps, sub-mucosal fibroids and atrophy of the endometrium Cancer and hyperplasia are present in 20 % of women with postmenopausal bleeding A biopsy should be performed to evaluate the endometrium in women with postmenopausal bleeding Diagnosis Hysteroscopy with endometrial curettage or endometrial sampling，curettage alone，or outpatient endometrial sampling alone，are essential．Curettage is not infallible．On the other hand，if a Pipelle has been correctly introduced（record how many cm）and the pathology is benign, or no tissue is obtained，it