上海交通大学医学院：《妇产科学》（双语） 6 CARCINOMA OF THE ENDOMETR工UM

CARCINOMA OF THE ENDOMETRIUM Wen Di M.D., Ph D

2003-10-27 Carcinoma of the Endometrium 1 CARCINOMA OF THE ENDOMETRIUM Wen Di , M.D.，Ph.D

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 2003-10-27 Carcinoma of the 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 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 2003-10-27 Carcinoma of the endometrium 3

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．

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 ncidence of endometrial carcinoma 2003-10-27 Carcinoma of 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 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 2003-10-27 Carcinoma of the endometrium 5

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 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. 2003-10-27 Carcinoma of the 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 Carcinoma Factor Discussion Relative Risk Menopause 2. 4 times more likely for women undergoing menopause after age 52 than between 49 and 52 Unopposed Estrogen replacement without progestins; risk 4-8 estrogen increased with dosage and duration of use rapy Nulla Obesity 3 times more likely at 20-50 pounds overweight 3-10 10 times if more than 50 pound overweight; associated with aromatization of adrenally produced androstenedione estrone in fat cells Tamoxifen therapy 2-3 Diabetes mellitus 2003-10-27 Carcinoma of the endometrium

2003-10-27 Carcinoma of the Endometrium 7

Oral contraception, especially after long term use, reduces the incidence of both endometrial and ovarian carcinomas 2003-10-27 Carcinoma of the 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 induced by tamoxifen produces endometrial polyps. A report in the Lancet in 1999 suggested a four-fold increase in endometrial carcinoma 2003-10-27 Carcinoma of the endometrium 9

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．．

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 2003-10-27 Carcinoma of the endometrium

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．