妇产科学教学课件：13-2Endometrial Carcinoma 1.ppt

Age 58 , G2P0Irregular bleeding for 2 months.Menopause at age 52. Past history: diabetes mellitus for 3 years.Case Report 1 of 3 common malignant tumors of female reproductive systemGeneral Consideration Endometrial carcinoma Cervical cancer Ovarian cancer 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 Estrogen-dependent Endometriod adenocarcinoma prognosis is good Estrogen-independent Other kinds of pathological types prognosis is poor Risk factors1. Estrogen stimulation (1) Exogenous estrogen stimulation estrogen replacement therapy tamoxifen (2) Endogenous estrogen stimulation polycystic ovary syndrome (PCOS) ovarian granulosa cell tumor（卵巢颗粒细胞肿瘤） Risk factors 2. Triple sign Diabetes Obesity Hypertension 3. infertility ， delayed menopause 4. Genetics factor family history of breast cancer or endometrial cancer ( 20% ) Pathology1. Gross Pathology Diffuse lesions 弥漫性病变 Focal lesions （局灶性损害） fundus corner 2. Histological typesEndometriod adenocarcinoma （popular）子宫内膜样腺癌80%-90%Serous carcinoma（浆液性癌）mucinous carcinoma （粘液性癌）Clear-cell carcinoma（透明细胞癌）mixedadenocarcinoma （混合性腺癌）10 Spread Patterns Direct spread Lymphatic metastasis Hematogenous spread 1. Direct spreadcorner of uterus to fallopian tube cervix and vagina myometrium to serosa of uterus pouch of Douglas and peritoneum 2. Lymphatic metastasis ------ main spread patternWhen the cancer invade cervix, depth myometrium or poor differentiation, it is easy to occur lymphatic spread in early time. metastasis approach relates to the position of tumor 3. Hematogenous spread ------ cancer of late stage lung, liver, bone