(妇产科学教材）12.4Endometrial Carcinoma.pptVIP

; Age 58 , G2P0 Irregular bleeding for 2 months. Menopause at age 52. Past history: diabetes mellitus for 3 years.; 1 of 3 common malignant tumors of female reproductive system; 7% of all malignant tumors in women 20%~30% of malignant tumors in female genital system peak incidence at age 58 -- 61 75% postmenopause 25% pre-menopause ( 5% age 40 );Pathogenesis;Pathology; Focal lesions fundus corner ;2. Histological types;A. Endometriod adenocarcinoma;A. Endometriod adenocarcinoma 80%~90% 5-year survival rate: 65% the higher histological grade is, the worse prognosis of patient is.;B. Adenocarcinoma with squamous differentiation 4%~5% adenoacanthoma adenosquamous carcinoma adenocarcinoma with squamous atypical hyperplasia ;C. Serous carcinoma papillary structures, arrange irregularly psammoma bodies ; D. Clear-cell carcinoma plenty kytoplasm, nuclei obvious atypia easy to metastasize early, poor prognosis;Spread Patterns;1. Direct spread; 2. Lymphatic metastasis; 3. Hematogenous spread;Staging ;Surgical-pathological staging;Surgical-pathological staging;Clinical Findings ; Symptoms 2. Vaginal discharge bloody discharge, serous discharge 3. Lower abdominal pain due to uterine contraction; signs no specific result from pelvic examination uterus may be enlarged and soft uterus may be fixed and immobile in advanced cases;diagnosis;Ultrasound with color flow imaging Endometrial thickness ≥5mm after menopause;4. Fractional dilation and curettage (DC) ;5. Hysteroscopy direct observe uterine cavity more accurate curettage of endometrium; Differential Diagnosis;Treatment ;Surgical measures Stage I：total hysterectomy and bilateral salpingo-oophorectomy lymph node sampling pelvic and paraaortic lymphadenectomy Stage II : same as the cervical cancer