Medical Archive

Uterine Cancer (FIGO 2023)

Epidemiology and risk factors

  • The m/c risk factor is obesity.
  • Protective factors
    • Oral contraceptives (E+P)
    • Tobacco use
      • Stimulating estrogen metabolism in the liver and decreasing serum estrogen levels.
Age-standardized global incidence (per 100,000 person-years) of cancers of the corpus uteri.

## Endometrial biopsy indications

  • Age ≥45
    • Abnormal uterine bleeding
    • Postmenopausal bleeding
  • Age <45
    • Abnormal uterine bleeding PLUS:
      • Unopposed estrogen (obesity, anovulation)
      • Failed medical management
      • Lynch syndrome (HNPCC)
  • Atypical glandular cells on Pap.
    • Age <35: common, benign especially during the menstrual cycle
    • Age ?35: need colposcopy + ECC + biopsy

Endometrial hyperplasia

Risk factor

  • Unopposed Estrogen
    • Nullipara / late menopause
    • PCOS
    • Granulosa-theca cell tumor
    • OCS(single)
    • tamoxifen / raloxifen
  • Obesity

Diagnosis

???: ?? ??, ????, ????
???: ? ?? (??? 5-10%)

  • USG
    • Premenopuase 14mm
    • After menopause 4mm
  • Aspiration Bx, Hysteroscopy, D&C
    C14 Benign Diseases of the Female Reproductive Tract

Treatment

Progestin Tx? 2-3???. ?? 1?? ? Bx ????.

PremenopausalPostmenopausal
NO atypiaCyclic low PCyclic low P
WITH atypiaContinuous high P
TAH c BSO		TAH c BSO
  • If Cyclic low P fails, Cont. low P
  • Continuous high P: 3month f/u Bx/TVUSG.

Endometrial cancer

Similar risk factors with hyperplasia. + HNPCC – POF

Type Type I (75%) Type II (25%)
Cause E dependent E independent, p53 mutation is common.
Arises from? Endometrial hyperplasia Atrophic hyperplasia
Histology Endometrioid Papillary structures with psammoma body
Age Younger Older
Prognosis Favorable Poor

Clinical presentation

???? ? ?? (90%), ?? ?? ??? DDx: ?? ?? ?? – m/c

Diagnosis

Physical exam: Pelvic exam, US;?? ??? 4mm??? ??
Screening test: ??. ???? Pap, cytology, USG(???? ??? ??? ?), CA125
US: ??? 14mm, ?? ? 4mm
Aspiration Bx
Hysteroscopy
D&C

Staging process

Surgical Flow
Peritoneal fluid cytology ? abdomen/pelvis explore ? TAH&BSO ? uterine specimen eval. ? suspicious LN sampling

Staging
Surgically, after TAH+BSO.

Histology
Bad: nonsquamous or nonmorular solid growth pattern
G1: ~5% / G2: 5~50% / G3: 50%~

Molecular profiling

Suggested molecular profiling workflow in patients with endometrial
cancer. MMR, mismatch repair; MMRd, mismatch repair-deficient; MMRp, mismatch
repair-proficient; MSI, microsatellite instability; MSI-H, microsatellite instability-
high; MSS, microsatellite stable; NSMP, no specific molecular profile; POLE, DNA
polymerase ε; PR, progesterone receptor.

Treatment

Stage I EC: surgery
Stage I-IVA EC: adjuvant therapy for low- and intermediate-risk patients.
Stage I-IVA EC: adjuvant therapy for intermediate- and high-risk patients
Locoregional recurrent EC.
Metastatic EC.

Pelvic, para-aortic LND Indication

  • Histology
    • Non-endometrioid (serous, clear, squamous)
    • Grade 2-3 endometrioid
  • ???? 1/2 ?? ?? (stage IB ??)
  • ?? ?? >2cm
    • ??? 2cm ??? ?? pelvic,
    • Pelvic?? ??? para-aortic??.
  • Isthmus-cervix extension
    • ?? ? ?? ??

Recurrence risk

  • Risk factors
    • 60? ??
    • LVSI (+)
    • Size >2cm
    • Uterine ?? ??
  • Risk factor ?? ?? RTx or CTx ??? ??.
  • RTx
    • Stage IA G2~: vaginal brachytherapy (local)
    • Stage IA G3~: pelvic RTx (external)
    • + Extended field RTx, whole abdomen RTx, Etc.
  • CTx


surgical staging ?
RTx
IB G3 RF+ ??? ??? RTx ?? ??.
Vaginal vault < External pelvic < Extended field < Whole abdomen
CTx
IB G3 RF+, II G3 ??? CTx ?? ? ??. III?? ??? ????.

???
1/4??, ??? 2? ??. Vagina>pelvis>lung>LN
??? ? ???. Palliative, RTx ?????? ??????

??? ? ???? ?? ??? E ??? controversial
??? ????? – IB?? ??? RTx. ?? ?? ????? ????.

Uterine sarcoma

Risk factors

Pelvic radiation, tamoxifen use, postmenopausal patients

Presentation

Abnormal/postmenopausal bleeding
Pelvic paian or pressure
Uteraine mass

Diagnosis

Ultrasound +/- additional imaging
Endometrial biopsy
Histopathology of surgical specimen

Leiomyosarcoma

Malignant proliferation of smooth muscle arising from the myometrium(usually seen in postmenopausal women).
Arises de novo; leiomyosarcomas do not arise from leiomyomas.
Gross exam often shows a single lesion with areas of necrosis and hemorrhage; histological features include necrosis, mitotic activity, and cellular atypia.