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1、Endometrial CarcinomaGeneral Considerations Endometrial carcinoma is one of the most three common pelvic genital cancer in women.It is malignant epithelioid tumor. The incidence of endometrial cancer has now raised. The peak incidence of onset is in the age 58-61 years.Etiology Etiology of endometri

2、al carcinoma may involve two mechanisms estrogen-dependent estrogen-independentcertainPathologyEndometrioid adenocarcinomaSerous adenocarcinomaClear cell carcinomasMucus adenocarcinoma OthersMETASTASISDirect invasionLymphatic metastasis Vascular metastasis(advanced stage)SYMPTOMS mostly of the disea

3、se occurs in the elder patients,there is no symptoms at the very early stage and it is only discovered by examine. abnormal vaginal bleeding vaginal fluiding. pelvic painweakness, weight loss, and anemia Physical examination is usually unremarkable at the very early stage. the uterus may be enlarged

4、 and the mass may move out of the cavity in the advanced cases.Some signs of metastasis can be found of the late stages of the diseaseSIGNS Diagnosis History：clinical representation and high risk factor, family historyvaginal bleedingHigh-risk factorsLong term use of E2,TAMFamily history of breast c

5、ancer and endometrial carcinomasSigns Special ExaminationsFractional curettage Endometrial biopsyEndocervical curettageDiagnose of endometrial carcinoma needs the pathologic resultsEndometrial cytology exam are also used in some patients. Ultrasonography can be helpful in deciding clinical staging,

6、In postmenopausal women, 4mm is the cut off for a normal unilateral endometrial stripe. The function of cavityscopy is controversy. MRI and CT appear to improve the accuracy of clinical staging and is particularly helpful in identifying myometrial invasion. Serum CA-125, a well-established tumor mar

7、ker can also be useful for endometrial cancer. Special ExaminationsDifferentiationDysfunctional uterine bleeding in the menopause women Senile vaginitisEndometrial polypusPelvic genital cancer in womenEndometritis in eldersCLINICAL STAGE According to anatomic sitesStage I： endometriumStage II： cervi

8、xStage III: parametrial，within pelvisStage IV：beyond metastasisClinical staging(FIGO1971)According to the Fractional curettage and clinical examinationPre-operation stagingUsed in the patients who treat Radiation as primary therapySurgical-pathological staging (FIGO1988)the last staging for the pati

9、ents who choose surgery as the principal therapyIt is the last staging for the majorityStagingTHERAPY Treatment plan for endometrial carcinoma depends on its clinical staging and common conditionSurgery , radiation therapy and drugs are all in usePrimary surgery with concomitant therapy is the main

10、treatment in the early stage patients While in the late stages of the disease include radiation, surgery and drugs therapy. Surgical treatment :Primary treatment, especially in the early stagesPurposeDefinitude the staging and prognostic factorsExcise the lesion THERAPYSURGICAL TREATMENT clinical st

11、age simple hysterectomy and bilateral salpingo-oophorectomy has been recommended Make sure to obtain peritoneal washings for cytologic identification of occult spread. The uterus should be opened in the operating room to determine the need for lymphadenectomy. The need for lymphadenectomySpecial pat

12、hological typeGreater than 50% myometrial invasion Low differentiation（G3） 50 cavity be involved by the lesionCervical extension SURGICAL TREATMENT SURGICAL TREATMENT clinical stage II radical hysterectomy and bilateral salpingo-oophorectomy has been recommended pelvic and para-aortic lymphadenectom

13、y is necessary Make sure to obtain peritoneal washings open the uterus in the operation and expect the PR and ER receptors. SURGICAL TREATMENT clinical stage ， cytoreductive surgery should be attempted if possible Radiation therapy simply is used in patients with operation forbiddance or in the late

14、 stages. Postoperative adjuvant radiation therapy is indicated in patients with extrauterine extension lower uterine segment or cervical involvement myometrial invasion 1/2 poor histologic differentiation papillary serous or clear cell histology RADIATION THERAPY Adjuvant radiation therapy preoperat

15、ively is indicated in reducing tumor size to create operation condition and eliminate the hiding metastasis lesion. Radiation therapy can be carried out inside or outside body.RADIATION THERAPY HORMONE THERAPY Progesterone has been the treatment of recurrent endometrial carcinoma not amenable to irr

16、adiation or surgery. Patients who are young also use progesterone therapy to keep fertility. The drugs are manual composed with high dose. curative effect should be estimated every 2-3months. Tamoxifen has been used as another hormonal agent in advanced or recurrent endometrial cancer ANTITUMOR CHEMOTHERAPY Chemotherapy of single drug or combined drugs i