CARCINOMA OF THEENDOMETRIUM
2003-10-27 Carcinoma of the Endometrium 1 CARCINOMA OF THE ENDOMETRIUM
One of the commonest gynecologicalcancers, especially in white Americans,it occurs most often in postmenopausalwomen (up to 80%of cases) with lessthan 5% diagnosed under 40 years ofage.2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 2 • One of the commonest gynecological cancers，especially in white Americans， • it occurs most often in postmenopausal women（up to 80％of cases）with less than 5％ diagnosed under 40 years of age．
There is no effective screeningprogramme, but occasionallycervical smears contain endometrialcancer cells or double thicknessendometrial ultrasonic thickness of4mm or more indicates a need forendometrial sampling2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 3 There is no effective screening programme，but occasionally cervical smears contain endometrial cancer cells or double thickness endometrial ultrasonic thickness of 4mm or more indicates a need for endometrial sampling．
RiskFactorsThe actual cause of this cancer is unknown,Estrogengiven estrogenalone aspostmenopausal hormone replacementtherapyEstrogen secreting tumors of theovary are associated with an increasedincidence of endometrial carcinoma.2003-10-27Carcinomaof the Endometrium
2003-10-27 Carcinoma of the Endometrium 4 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．
There can be no doubt that oestrogencan alter the behaviour of this tumour butthere is still a question about oestrogen as aprimary causal agent.Approximately 75%of cases ofendometrial cancer occur in thepostmenopausal period when estrogen valuesare low and progesterone isabsent. Nulliparity and PCO syndrome (withdefective progesterone synthesis) carry anincreased risk.2003-10-27Carcinomaof the Endometrium
2003-10-27 Carcinoma of the Endometrium 5 There can be no doubt that oestrogen can alter the behaviour of this tumour but there is still a question about oestrogen as a primary causal agent． Approximately 75％of cases of endometrial cancer occur in the postmenopausal period when estrogen values are low and progesterone is absent．Nulliparity and PCO syndrome（with defective progesterone synthesis）carry an increased risk．
Only a proportion of obese, diabetic andhypertensive women develop endometrialcancer and similarly only a proportion ofwomen with endometrial cancer are obesediabetic or hypertensive. The questionremains whether estrogen is a causal agentor is acting in its normal capacity as agrowth factor and is really to be regardedasa co-carcinogen.2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 6 Only a proportion of obese，diabetic and hypertensive women develop endometrial cancer and similarly only a proportion of women with endometrial cancer are obese， diabetic or hypertensive．The question remains whether estrogen is a causal agent， or is acting in its normal capacity as a growth factor and is really to be regarded as a co－carcinogen．
Risk Factors for Endometrial Hyperplasia and CarcinomaDiscussionRelative RiskFactor2~32.4 times more likely for women undergoingMenopausemenopause after age 52 than between 49 and 524-8UnopposedEstrogen replacement without progestins; riskincreased with dosage and duration of useestrogentherapy2-3Nulliparity3-10Obesity3 times more likely at 20-50 pounds overweightup to 10 times if more than 50 poundsoverweight; associated with aromatizationof adrenally produced androstenedione toestronein fat cells2-3Tamoxifen therapy3Diabetes mellitus2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 7
Oral contraception, especially afterlong term use, reduces the incidenceof both endometrial and ovariancarcinomas2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 8 Oral contraception，especially after long term use，reduces the incidence of both endometrial and ovarian carcinomas．
The endometrial hyperplasia inducedby Tamoxifen produces endometrialpolyps. A report in the Lancet in1999 suggested a four-fold increasein endometrial carcinoma.2003-10-27Carcinomaofthe Endometrium
2003-10-27 Carcinoma of the Endometrium 9 The endometrial hyperplasia induced by Tamoxifen produces endometrial polyps．A report in the Lancet in 1999 suggested a four-fold increase in endometrial carcinoma．．
SymptomatologyThe usual presenting symptom of endometrialcarcinoma is postmenopausal bleedingwhich carries a 10% risk of associatedmalignancy in the absence of hormonereplacement therapy. Curettage, orendometrial sampling is mandatory.Postmenopausal discharge frompyometra carries a 50% risk of associatedmalignancy. Pain may occur with pyometraor metastatic spread.2003-10-27Carcinomaofthe Endometrium10
2003-10-27 Carcinoma of the Endometrium 10 Symptomatology The usual presenting symptom of endometrial carcinoma is postmenopausal bleeding which carries a 10％ risk of associated malignancy in the absence of hormone replacement therapy. Curettage，or endometrial sampling is mandatory. Postmenopausal discharge from pyometra carries a 50％ risk of associated malignancy. Pain may occur with pyometra or metastatic spread．