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ENDOMETRIUM
Wen Di ,
M.D. Ph.D
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Carcinoma of the En
2003-10-27
Carcinoma of the En
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
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Symptomatology
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Diagnosis
Hysteroscopy with endometrial curettage
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Staging
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Local Spread
Slow invasion of the myometrium is
the commonest spread. It may
produce
considerable
uterine
enlargement; or spread may involve
the vaginal vault.
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Venous Spread
This pathway might account for the
occasional appearance of a low vaginal
metastasis; but venous spread is not a
common feature of uterine cancer.
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Lymphatic Spread
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Tubal Spread
Malignant cells can pass along the
tube in the same way that peritoneal
spill may occur during menstruation.
This may account for isolated ovarian
metastases.
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Stage
I
II
III
IV
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5 year survival
85%
68%
42%
22%
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Stage I
Total abdominal hysterectomy and bilateral
salpingo-oophorectomy without partial
removal of vagina. Peritoneal saline
washings are taken for cytology on opening
the abdomen and the Abdominal contents
carefully examined Vaginal hysterectomy
with removal of ovaries, sometimes
laparoscopy-assisted has equal 5 year
survival and lower operative mortality in
appropriate hands
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Stage II
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Stage III
Following the Staging laparotomy radical
hysterectomy lymphadenectomy paraaortic node sampling and removal of as
much malignant tissue as
possible omentectorny is carried out
Stage III diseases limited to the pelvis
may be treated by radiotherapy
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Stage IV
Treatment of this Stage is designed
to control tumour growth and alleviate
symptoms Surgery radiation
therapy cytotoxic therapy and
adjuvant progestogen therapy all have
a place
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PROGESTOGENS
Many endometrial carcinomata are
hormone dependent and progestogens
have been used as part of a combined
primary treatment as well as for
recurrent or metastatic growths
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Chemotherapy
Cytotoxic chemotherapy has a limited
place in advanced recurrence Single
agent therapy with adriamycin,
cisplatinum ,cyclophosphamide and
hexamethylmelamine gives response
rates between 20 and 40
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