Endometrial Cancer

Endometrial cancer are usually endometrioid adenocarcinomas. Typically occur postmenopausal vaginal bleeding. The diagnosis is made by biopsy. The staging (staging) is done surgically. Treatment requires hysterectomy, bilateral Salpingoovarektomie, mostly pelvic and para-aortic lymphadenectomy and excision of all probably affected tissue. In advanced tumor radiotherapy, hormone therapy and cytotoxic therapy is usually indicated.

Endometrial cancer are more common in industrialized countries where a high-fat diet is common. In the United States makes this carcinoma with 1:50 affected the fourth most common cancer in women and may be more common even as the prevalence of metabolic syndrome increases. For 2013, it was estimated that the endometrial cancer was diagnosed in 49,560 women in the US and died that 8190 women in this carcinoma.

Endometrial cancer are usually endometrioid adenocarcinomas. Typically occur postmenopausal vaginal bleeding. The diagnosis is made by biopsy. The staging (staging) is done surgically. Treatment requires hysterectomy, bilateral Salpingoovarektomie, mostly pelvic and para-aortic lymphadenectomy and excision of all probably affected tissue. In advanced tumor radiotherapy, hormone therapy and cytotoxic therapy is usually indicated. Endometrial cancer are more common in industrialized countries where a high-fat diet is common. In the United States makes this carcinoma with 1:50 affected the fourth most common cancer in women and may be more common even as the prevalence of metabolic syndrome increases. For 2013, it was estimated that the endometrial cancer was diagnosed in 49,560 women in the US and died that 8190 women in this carcinoma. Endometrial cancer occur mainly in postmenopausal women. The mean age at diagnosis is 61 years. Most cases are diagnosed in the age group of 50 to 60 years, 92% of cases occur> 50 years in women. Etiology main risk factors are obesity diabetes hypertension Other risk factors include estrogen monotherapy tamoxifen intake> 5-year Preceding pelvic radiation Personal or family pre-existing conditions from breast cancer or ovarian cancer Familial previous illness of hereditary nonpolyposis colorectal cancer or possibly endometrial cancer in first-degree Predominant estrogen levels (high circulating levels of estrogen with low or missing progestin mirrors ) can occur without the addition of progestins in obesity, polycystic ovary syndrome, nulliparity, later menopause, estrogen-producing tumors, anovulation (ovarian dysfunction) or estrogen administration. Hereditary disposition plays a role in up to 10% of endometrial carcinoma; about half of these cases occur in families with hereditary nonpolyposis colorectal cancer (Lynch syndrome) on. Most pathology is endometrial hyperplasia precedes the endometrial cancer. Adenocarcinomas account for> 80% of endometrial cancer. Endometrial adenocarcinomas are usually divided into two types. Tumors of the type I are more common, talking on estrogen and are usually diagnosed in younger, obese or perimenopausal women. These tumors are usually low-grade. Histology is usually endometroid. These tumors may have microsatellite instability and mutations in PTEN, PIK3CA, KRAS and CTNNBI. Tumors of the type II are usually highly (serous z. B. or clear cell histology). You are more likely in older women. In about 10-30% of p53 mutations are present. Up to 10% of endometrial adenocarcinomas are Type II endometrial var model = {thumbnailUrl ‘/-/media/manual/professional/images/endometrial_cancer_high_blausen_de.jpg?la=de&thn=0&mw=350’, imageUrl: ‘/ – /. ? media / manual / professional / images / endometrial_cancer_high_blausen_de.jpg lang = en & thn = 0 ‘, title:’ endometrial cancer ‘, description:’ ‘credits”, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true }; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); The tumor can spread from the surface of the uterine cavity into the cervical canal through the myometrium in the serosa and the abdominal cavity through the lumen of the fallopian tube to ovaries, broad ligament of the uterus and peritoneal surfaces or by hematogenous metastasis or lymphogenous metastasis remote. The higher the histologic grade is (low differentiated), the greater the probability of a deep Myometriuminfiltration, a pelvic or para-aortic Lympknotenmetastasierung or extrauterine propagation. Symptoms and signs Most (> 90%) patients have abnormal vaginal bleeding (eg, postmenopausal bleeding, recurrent premenopausal metrorrhagias.); one third of all patients with postmenopausal bleeding have endometrial cancer. A vaginal discharge may precede bleeding postmenopausal weeks or months. Diagnostic endometrial biopsy Intraoperative staging suspicion of endometrial cancer is in Postmenopausal bleeding Premenopausal women with abnormal bleeding Postmenopausal women with proven endometrial cells in routine Pap test to all women with atypical endometrial cells in routine Pap test case carcinoma suspicion is an outpatient procedure endometrial biopsy; the results are reliable to> 90%. Endometrial sampling also women with abnormal bleeding, especially from the age of> 40 years recommended. If the results are ambiguous or indicate malignancy (complex hyperplasia with atypia), is carried out stationary curettage with hysteroscopy. Alternatively, a transvaginal ultrasound scan can be performed; However, a histological diagnosis is required. A secure carcinoma diagnosis, the pre-therapeutic diagnosis consists of determination of serum electrolytes, renal and liver function parameters, blood count, chest x-ray and ECG. Pathological liver function tests An abdominal mass or Hepatomegaie is detected during the physical examination The carcinoma, a histological subtype with high risk (eg, papillary serous: to clarify possible ectopic or metastatic tumor manifestations an abdominal and pelvic CT is made in the following cases. carcinoma, clear cell carcinoma) staging the staging is based on the histological differentiation (Grad 1 [the least aggressive] to 3 [most aggressive]) and the extent of the spread, including invasion depth, infection of the cervix (glandular versus stromal invasion) and the presence of ectopic metastasis ( staging of endometrial cancer). Staging is performed intraoperatively, with peritoneal fluid cytology, exploration of the abdomen and pelvis, and biopsy or excision of suspicious lesions and extrauterine pelvic and paraaortic lymphadenectomy. During the intraoperative staging a complete abdominal hysterectomy and bilateral Salpingoovarektomie be performed. Intraoperative staging can be done by laparotomy, laparoscopically or using robot-assisted system. Staging of endometrial cancer stage *, † Definition I on the corpus uteri IA limited tumor on the endometrium is limited or invasion of less than 50% of the myometrium IB invasion of 50% or more of the myometrium II infection of the uterus and cervix, but no extension beyond the uterus out III Local or regional extent of the tumor IIIA infestation of serosa, adnexa or both (direct expansion or metastases) IIIB metastases or direct expansion in the vagina or parametrium IIIC Pelvic and / or para-aortic lymph node metastases IIIC1 Pelvic lymph node metastases IIIC2 Para-aortic lymph node metastasis with or without pelvic lymph node metastases IV infection of the urinary bladder, intestinal mucosa or distant metastases IVA infection of the bladder and / or intestinal mucosa IVB Distant metastases including intra-abdominal and / or inguinal lymph node metastases * The staging of endometrial cancer is usually intraoperatively. † Except for stage IVB, the degree of differentiation (G) depends on the portion of the tumor with non-plattenepithelzelligem or non-morulaartigem solid growth pattern: G1: ? 5% G2: 6-50% G3:> 50% An inappropriately high for the degree rate of nuclear atypia increases the degree of differentiation of a G1 or G2 tumor by 1. in serous adenocarcinomas, clear cell adenocarcinomas and squamous has the graduated nuclear atypia according to priority. Adenocarcinomas with Plattenepitheldifferenzierung be divided according to the Karnatypien the glandular component. * According to the staging systems of the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC), AJCC Cancer Staging Manual, 7th edition, New York, Springer, 2010. A prognosis is poorer prognosis in undifferentiated tumors ( high G), extended tumor manifestation and high patient age. The average 5-year survival rate for stage I or II: 70-95% stage III or IV: 10-60% Total 63% of patients are at least 5 years after treatment tumor free. Usually, treatment complete hysterectomy and bilateral Salpingoovarektomie Pelvic and para-aortic lymphadenectomy with deep (> 50% myometrial invasion) Grade 1 or Grade 2 and Grade 3 tumors radiotherapy of the pelvis with or without chemotherapy in stages II III or multimodal, individually established therapy in stage IV in a tumor in stage I / G1 without deep myometrial invasion, the probability of undetected lymph nodes metastasis is below 2%. Usually, the treatment here consists of a complete hysterectomy and bilateral Salpingoovarektomie, either by laparotomy, laparoscopic or robotically. For grade 1 or grade 2 tumors with ? 50% myometrial invasion or tumor grade 3 beyond a complete pelvic and para-aortic lymphadenectomy is made. Whether the para-aortic lymph node dissection will be up to the inferior mesenteric artery or renal vessels extended is further discussed. The tumor stages II and III requiring radiotherapy of the pelvis with or without chemotherapy. The treatment of stage III must be individualized, but laparotomy remains an option; generally have patients who receive a combined surgical and radiotherapeutic treatment, a better prognosis. With the exception of patients with large-volume tumor disease and infestation of parametria a complete abdominal hysterectomy and bilateral Salpingoovarektomie should be performed. The treatment of stage IV is different and patient-dependent, but typically involves a combination of surgical, radiotherapeutic and chemotherapeutic treatment approaches. Occasionally, a hormone treatment should be considered. Hormone replacement therapy with a progestin reaches up to 3 years of tumor regression in 20-25% of patients. Also, pulmonary, vaginal and mediastinal metastases may regress. The treatment is continued as long as a tumor response is made. Several cytotoxic drugs (in particular, cisplatin plus paclitaxel) are effective. They are given mainly women with metastatic or recurrent carcinoma. Another option is the administration of 60 mg / m2 doxorubicin plus 60 mg / m2 cisplatin i.v., achieved response rates of ? 50%. The treatment of endometrial hyperplasia is composed of progestogen or surgery (z. B. curettage), depending on the complexity of the lesion and the desire of the patient to avoid a hysterectomy. In young patients with Grade 1 tumors and without myometrial invasion (MRI detected) and with existing Fertility a sole administration of gestagen is possible. Approximately 46-80% of patients have a complete response within an average of three months. After 3 months, patients should be evaluated by curettage instead of endometrial biopsy. Summary Endometrial carcinoma is the most common cancer in women and is more common, as the prevalence of metabolic syndrome increases. The prognosis is favorable appeal in type I tumors that are diagnosed more in younger or perimenopausal women on estrogen and have favorable histologic features. There we recommend an endometrial sampling especially in women over 40 years with abnormal bleeding. The staging of endometrial cancer is effected intra-operatively by laparotomy, laparoscopy or surgical robot system. Usually, the treatment consists of complete hysterectomy and bilateral Salpingoovarektomie, occasionally with lymph node dissection, radiation therapy and / or Chemotherapy.

Health Life Media Team

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