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Endometrialcarcinoma子宮內(nèi)膜癌1GeneralconsiderationTheendometrialcarcinomaisoneofthethreemajorgynecologicalmalignanttumor,anditsprognosisisconsiderablebetterthantheother.Thepeakincidenceofonsetis50-60yearsold(perimenopause、menopause).2ConsecutivestimulatingofestrogenforlongtimeEtiologySimpleHyperplasiaComplexHyperpiasiaAtypicalHyperplasiaEndometrialcancer3HighRiskFactorEstrogendependentEndogenousestrogen:Diabetesmellitus，obesityhypertensionPCOS，infertile，anovulatorycyclesearlymenarcheordelayedmenopauseovaryfunctionaltumor(granulosacelltumor,thecacelltumor)Exogenousestrogen:HRT(withoutprogestin),tamoxifenHereditaryfactorEstrogenindependent4GrossappearanceSpreadtype:WidespreadalmostalltheendometriumFilledallthecavity,butrarelyinvasivethemyometrium5GrossappearanceConfinedtype:MajorlimitedinthefundusorcornusUsuallyinvasivethemyometriumPolyps,papilla6HistologicalchangeAdenocarcinoma80%Adenocarcinomawithsquamousdifferentiation,adenosquamouscarcinomaPapillaryserousadenocarcinomaClearcellcarcinoma

poorprognosis7SpreadroutesDirectextension1Lymphaticmetastases2Peritonealimplants3Hematogenousspread48Thecancerhasdeeplyinvadedtheuterinesmoothmuscleandmetastasizedtoanovary.9Staging（FIGO2009）IAnonor<?myometrialinvasionIB≧?myometrialinvasionIITumorinvolvesthecervicalstromaIIIATumorinvadesserosaoradnexaIIIBVaginaland/orparametrialinvolvementIIIC1PelviclymphnodeinvolvementIIIC2Para-aorticlymphnodeinvolvement,withorwithoutpelvicnodeinvolvementIVATumorinvasionbladdermucosaand/orbowelmucosaIVBDistantmetastasesincludingabdominalmetastasesand/oringuinallymphnodes10111213SymptomsAbnormalvaginalbleeding,especiallyaftermenopause

themostimportantwarningsignVaginaldischarge:withinfectionPainGeneralmanifestation14PhysicalsignsUsuallyunremarkableIfthecancerisextensive,theuterusmaybeenlargedandsoftWithadvancedcases,theuterusmaybefixedandimmobilefromparametrialadnexalandintraperitonealspread.Theuterusisnotatrophicaftermenopause.15AssistantexaminationPelvicultrasonographymeasurethethicknessoftheendometriuminpostmenopausalwomen≦4mmEnlargeduterus,solidoccupiedlesionintheuterinecavity16solidoccupiedlesionintheuterinecavity

enlargeduterus17AssistantexaminationFractionalcurettageIt's

necessaryfordiagnosingthecancer.Completecurettageoftheendocervicalcanalshouldbefollowedbydilationofthecanalandcurettageoftheendometrialcavity.Ifthereissufficienttissuetoanalysis,theprocedureshouldbeterminated.18AssistantexaminationHysteroscopy(thegoldenstandard)192021AssistantexaminationEndometrialbiopsyoraspiration——CytologicexaminationCT,MRICA-12522DifferentialdiagnosisDysfunctionaluterinebleedingperi-menopause.SenilevaginitisCervicalcarcinomaSubmucousmyomaorendometrialpolypsPrimarycarcinomaoffallopiantube23TreatmentSurgeryTotalhysterectomywithbilateralsalpingo-oophorectomy,andselectivepelvicandperiaoticlymphnodebiopsies.pelvicwashings24RadiumtherapyChemicaltherapyHormonetherapylargedosesofprogestins:medroxyprogesterone:250mgqdpo.Megestrolacetate:

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