Prof.

Siva Achanna FRCOG,

Dept. of Obstetrics & Gynaecology,
Mahsa University, Kuala Lumpur.

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 Introduction
 Endometrial Ca is an adenocarcinoma
whilst Cervical Ca is squamous cell
carcinoma
 Endometrial Ca is within a closed muscular
box, it spreads by direct invasion
 The prognosis is slightly more favourable
than that of cervical carcinoma

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 Anatomy of female pelvis

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 Incidence
 Endometrial Ca used to be six times less
common than Cervical Ca, but now is
similar to the latter, because invasive
Cervical Ca has decreased because of
extensive screening

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 Age
 Found commonly in post-menopausal
women, its peak incidence is at 61. Three
quarters of the women are over the age of
50.

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 Parity, Obesity, Diabetes &
Hypertension
 These women are relatively infertile, only
half may have had one or more
pregnancies.
 There is no relationship with social class
 There is an association with obesity, DM
and hypertension
 Tend to produce more oestrone than
average by peripheral conversion in
peripheral fat
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 Risk Factors
 Age > 40
 Weight > 90 kg (200 lbs)
 Anovulatory cycles
 Nulliparity
 Infertility
 Tamoxifene use
 Family h/o Endometrial or Ca Colon

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 Differential Diagnosis
 Atrophic vaginitis 59 %
 Endometrial polyp 12 %
 Endometrial hyperplasia 10 %
 Endometrial Ca 10 %
 Hormonal effect 7%
 Ca cervix 2%
 Others <1 %

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 CT scan CA Endometrium

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 Role of HRT
 There is an increased risk of endometrial
cancer when oestrogen replacement is
given after climacteric
 If HRT is needed in patient with intact
uterus, it is best given with progestogen
for last 7-12 days cyclically
 Endometrial sampling must be done if
unopposed estrogen is given for more
than six months
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 Pathology
 Nearly always adenocarcinoma but there may be
squamous elements (adenoacanthoma)
 Histology-Diagnosis is clear cut due to
disordered architecture, atypical glands and
abnormal activity
 Spread is direct into the myometrium,
penetration to serosa is less common
 Pelvic node involvement noted in spread to
cervix and invasion of myometrium

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 CANCER UTERUS

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 CANCER UTERUS

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 CANCER UTERUS

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 Cut section of uterus with intact tumour

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 CANCER UTERUS GROSS PICTURE

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 Clinical Staging
 Stage O: Atypical hyperplasia suspicious of
malignancy
 Stage I: Ca confined to the body of uterus
 Stage 1a: Uterine cavity < 8 cm in length
 Stage 1b: Uterine cavity > 8 cm in length
 Stage 1 is further subdivided according to
the histology

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 Clinical Staging (cont.)
 Grade 1: Well differentiated tumour
 Grade 2: Differentiated tumour but with solid
areas
 Grade 3: Undifferentiated tumour or
predominantly solid areas

 Stage II : Ca involving the body and cervix

 Stage III: Ca outside the ut. but not outside true
pelvis
 Stage IV : Ca outside the true pelvis or
involvement of the bladder or rectal mucosa
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 Lung metastases

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 Clinical Features
 Irregular vaginal bleeding-intermenstrual
or postmenopausal
 Watery vaginal discharge in
postmenopausal women
 Abdominal and pelvic examination are
unremarkable except in late cases
 Careful diagnostic curettage, pipelle
biopsy or by scan of endometrial
thickening
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 Treatment
 TAHBSO and removal of a cuff of vagina
 Wertheim’s radical hysterectomy for
stage II disease
 Supplemental postoperative external
radiation is indicated if:
1. The tumour extends through more than
half of myometrial wall
2. The ovaries are involved
3. Growth extends to cervix
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 Treatment (cont.)

 High dose progestogen therapy for advance

cases if conventional methods have failed and
results in lung metastasis
Recurrent disease:
 Vaginal vault-Excision or intravaginal/external
irradiation
1. Lower ¼ of vagina-Interstitial radiotherapy
(radium needles)
2. Pelvic mass-Ext. radiotherapy
3. Distant metastasis (lungs or bone)-
Radiotherapy and/ or prostogen therapy
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 Prognosis
 The five year survival rate according to
the clinical staging is:
1. Stage I 75-80 %
2. Stage II 55-60 %
3. Stage III 35-40 %
4. Stage IV < 10 %

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 Sarcoma of the uterus
 These are rare tumours. Malignant
degeneration of leiomyoma accounts for
half of them but may arise from normal
myometrium or endometrial stroma
 Leiomyosarcoma: Most patients bet. 40-60
years
 Common symptoms are vaginal bleeding
and abdominal pain
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 Sarcoma botryoides

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 Treatment
 TAHBSO
 Radiotherapy is ineffective
 Endometrial sarcoma-bet. 50-70 years
 Signs & symptoms same as
leiomyosarcoma
 Sarcoma botryoides: common in
childhood, prognosis is poor, improved
with chemotherapy, radiotherapy and
extended hysterectomy and vaginectomy
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