Carcinoma Corpus Uteri Max Brinsmead MB BS PhD May 2015

Ca Endometrium – Burden of Illness As common as cancer of cervix 1:100 lifetime risk A disease of postmenopausal years Fortunately, most present early

Ca Endometrium – Histological Types Adenocarcinoma Adenoacanthoma Adenosquamous Papillary carcinoma Mixed Mullerian tumour (Spreads via lymphatics, blood and directly to ovaries and cervix/vagina)

Ca Endometrium - Staging Stage 1 – confined to body uterus Stage 2 – spread to cervix Stage 3 – beyond uterus but within pelvis Spread to bladder/bowel or distant metastases

Ca Endometrium – Diagnosis 1 Typically presents as postmenopausal bleeding However, only 10% with this symptom have Ca Must consider the patient at risk i.e: Nulliparous Infertile PCO syndrome Late menopause Obese/Hypertensive/Diabetic E2 therapy Genetic syndromes

Ca Endometrium – Diagnosis 2 Evaluation of the endometrium can be done by: Pap smear Vagina ultrasound – look at endometrial thickness Saline hysterography – good for polyps Endometrial sampling e.g. Pipelle D&C Hysteroscopy with fluid and biopsy is the gold standard And there is argument about who should get what test But this depends on the degree of risk

Ca Endometrium - Treatment Hysterectomy – including ovaries and sampling nodes/ peritoneal wash Radical hysterectomy if cervix involved Preop or Postop radiotherapy Progestin therapy

Ca Endometrium - Prognosis Overall 60 – 80% but also depends on: Stage Differentiation Depth of myometrial involvement Node or peritoneal involvement Hormone receptor status Medical condition of the patient

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