GLANDS: ADENOCARCINOMA

ENDOMETRIU
M

STROMA: ENDOMETRIAL STROMAL

GLANDS + STROMA: MMT
LEIOMYOSARCOMA

MYOMETRIUM
OTHERS

INTRODUCTION
Peak incidence is at
age of 61 years
75% occur in
postmenopausal
women
Only 5% occur before
age of 40
There is marked
geographical and
racial variation in the
incidence

PATHOLOGY
Growth is usually
adenocarcinoma
Adeno-acanthoma/
adenosquamous
tumors
Serous papillary/
clear cell
Grade 1 grade 3
Spread: Direct
invasion, Lymphatic,
Blood

ENDOMETRIAL
ETIOLOGY
Excessive unopposed estrogen
stimulation of the endometrium
Increase
Obesity, Nulliparity, Late
menopause, PCO, Estogensecreting ovarian tumors,
Unopposed estrogen therapy,
Family history of breast, ovary,
colon, endometrial tumors, DM
Decrease
OCCP, Progesterone

CARCINOMA
CLINICAL PRESENTATION
PMB
Intermenstrual
bleeding/irregular
periods
Heavy regular
periods
Watery
discharge/offensive
Pain
ENDOMETRIAL BIOPSY
SHOULD BE DONE IN
ALL PATIENTS WITH PMB

DIAGNOSIS
Always investigate PMB,
continuous or irregular
bleeding before assuming
benign cause for the bleeding
Cervical smear
TVS
Endometrial biopsy
Hysteroscopy +curettage
If confirmed, CBC,KFT,URINE,
MRI.CXR

PROGNOSIS
Stage
Grade
Myometrial invasion
Age
Tumor size
Assessment of these
factors require
laparotomy and
histology (surgical
pathological staging)

PHYSICAL FINDINGS
Rarely suggest the diagnosis
Uterine enlargement
Palpable lymph node in the
groin. Supraclavicle.
Vaginal nodule

TREATMENT
Low risk stage I: TAH, BSO
High risk: postoperative
radiotherapy
Stage II: TAH,BSO+
radiotherapy/radical
hysterectomy
Stage III /IV: individualized
.rarely surgery
usually chemo, radiotherapy
and hormonal
Follow up

 Recurrence usually within 2

years (70%)
Overall 5 year survival is 60%
FIGO STAGING
Stage 1
Confined to the body of
uterus
Stage 2
Involvement of cervix
Stage 3
Extension into
adnexae,vagina or
positive L.N
Stage4
Distant mets

ENDOMETRIAL SARCOMA
Endometrial stromal sarcoma
Malignant mixed mullerian tumors
(carcinosarcoma)
More in black. Previous pelvic irradiation
Present with bleeding and pain
Poor prognosis

LEIOMYOSARCOMA
5-10% May arise from transformation of fibromyoma (0.2%)
Mostly arise from normal myometrium
Peak incidence is 10 years older than fibromyoma
Present with abnormal bleeding and pelvic pain and wt loss
Should be suspected in rapidly enlarging fibroids
In 80%,diagnosis is made after hysterectomy
Ideally should be treated by TAH, BSO, washing and full
staging
Adjuvant radiotherapy or chemotherapy?