Uterine

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Uterine Ovarian Cancer

• Uterine Cancer
• Atypical Hyperplasia
• From hyperplasia to endometrial cancer
• Prevalence Incidence
• Causes
• Risk factors
• Detection
• Treatment
• Ovarian Cancer
• Risk factors
• Symptoms
• Detection
• Treatment

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I. Endometrial Cancer Uterine Cancer

• Endometrial cancer usually begins in the lining
  of the uterus (endometrium). It is sometimes
  called uterine cancer.
• Vast majority are adenocarcinomas commonly
  detected during perimenopause
• but there are other cells in the uterus that can
  become cancerous such as muscle or myometrial
  cells.

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A. Atypical Hyperplasia abnormal tissue growth

1. simple hyperplasia without atypia a
   proliferation of cells, but the basic structure
   of the endometrium is relatively unchanged
2. complex hyperplasia without atypia individual
   cells may be enlarged, but the internal makeup of
   the cells is considered to be normal.  However,
   the cells have proliferated to the point where
   the normal structure of the endometrium is
   interfered with.  
3. Hyperplasia with atypia precancerous,
   Approximately 25-30 of hyperplasia in this
   category will progress to endometrial cancer.

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B. From hyperplasia to endometrial cancer
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C. Prevalence Incidence

• ACS predicts that 41,200 American women will
  receive a diagnosis of uterine endometrial
  cancer this year, making it the fourth most
  common cancer found in women after breast
  cancer, lung cancer and colon cancer.
• Although this cancer is 40 more common in white
  women, black women are nearly twice as likely to
  die from it.

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D. What causes endometrial cancer?
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E. Risk Factors

1. obesity -- particularly being more than 50 pounds
   overweight (fat tissue can convert other hormones
   in the body into estrogens)
2. type 2 diabetes - some data suggest that women
   who have diabetes, whether they're obese or not,
   are at greater risk of endometrial cancer
3. early menstruation (periods starting before age
   12) late menopause (after age 52)
4. nulliparity (never having given birth) or a
   history of infertility (an inability to become
   pregnant)
5. ovarian diseases, such as polycystic ovaries,
   that may cause a woman to have higher than normal
   estrogen levels and lower than normal
   progesterone levels
6. estrogen-only replacement therapy (ERT)

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Additional potential contributors

• Family history possible genetic link
• Hereditary nonpolyposis colorectal cancer
  (HNPCC). Inherited disease caused by an
  abnormality in a gene important for DNA repair.
  Women with HNPCC also have a significantly higher
  risk of endometrial cancer.
• Personal history of breast cancer or ovarian
  cancer
• Stress

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F. Symptoms of endometrial cancer

• Abnormal uterine bleeding
• Heavy bleeding during or between periods, and
  bleeding after menopause.
• More frequent vaginal bleeding or spotting during
  the years leading up to menopause.
• In some cases, the discharge associated with
  endometrial cancer is pink, or white rather than
  red.
• Difficult or painful urination or pain during
  intercourse.
• In later stages of the disease, women may feel
  pelvic pain and experience unexplained weight
  loss.

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G. Detection

• Transvaginal ultrasound
• Hysteroscope

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Hysteroscope allows doctors to do a direct visual
examination of the endometrium. The lighted tip
of the instrument is inserted through the vagina
and cervix into the uterine cavity. There the
doctor can inspect any abnormal tissues and,
using a tiny electrified loop, can even take
samples for later lab analysis.
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Additional Diagnostic Tests

• CA-125 blood test
• Cystoscopy (to check for cancer in the bladder)
• Proctoscopy (to check for cancer in the rectum)
• Other imaging tests such as computed tomography
  (CT) scanning and magnetic resonance imaging
  (MRI), chest x-ray, or an intravenous pyelogram
  (x-rays of the pelvic region taken after the
  injection of a contrasting agent)

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H. Treatment

• Treatment of hyperplasia without atypia

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Treatment of hyperplasia with atypia

• The suggested treatment for atypical complex
  hyperplasia is usually hysterectomy
• In pre-menopausal women who wish to conceive,
  high dose progestin treatment with close
  monitoring is an accepted alternative to
  hysterectomy
• Cancer - Options for treatment depend chiefly on
  the stage of the disease (the size of the cancer,
  the depth of invasion, and whether the cancer has
  spread to other parts of the body).
• Radiation therapy and/or chemotherapy may be
  necessary

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Stages for endometrial cancer are

• Stage I. Cancer is limited to the uterus.
• Stage II. Cancer involves the uterus and cervix.
• Stage III. Cancer has spread out of the uterus
  but is restricted to the pelvic region.
• Stage IV. Cancer has spread to the bladder,
  bowel, or other distant locations.

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Survival rates

• 5 year survival rates for endometrial cancer by
  stage are

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• Mayo Clinic Site http//www.mayoclinic.com/health/
  endometrial-cancer/DS00306

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II. Ovarian Cancer

• For most pre-menopausal women, a growth on the
  ovary is benign (90) for post-menopausal women
  there is a 70 chance of it being benign
• Tumor growth that begins in the egg-producing
  cells (germ cell tumors)
• Tumor growth that begins on the surface of the
  ovary (epithelial cell tumors)

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• epithelial cell tumors
• Tumors of low malignant potential (LMP tumors) do
  not appear to be clearly cancerous.
• AKA borderline tumors.
• affect women at a younger age than other ovarian
  cancers.
• grow slowly and are much less serious than most
  ovarian cancers.
• Epithelial ovarian cancers Nearly 9 out of 10
  ovarian cancers are of this type.
• Grade 1 means the cells look more normal
• Grade 2 somewhat abnormal
• Grade 3 look highly abnormal.

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Prevalence Incidence

• An estimated 20,180 women will be diagnosed with
  ovarian cancer in the US in 2006.
• This year, about 15,310 women will die of the
  disease

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A. Risk Factors

• Continuous egg production (never pregnant, never
  used birth control, or first birth after age 30)
• Early menstruation (periods starting before age
  12) or late menopause (after age 52)
• Obesity
• Diet saturated fat increases risk, high fiber
  lowers risk
• Fertility drugs studies indicate prolonged use
  clomiphene citrate, especially without achieving
  pregnancy, may increase the risk for developing
  LMP tumors.
• Estrogen replacement therapy? - A recent study
  suggested that using ERT increases the risk of
  developing ovarian cancer, and that the risk
  increases with continued use.
• Genetics? the risk is higher among women whose
  close blood relatives (mother, sister, daughter)
  have (or had) this disease.
• lt10 of women found to have ovarian cancer have
  inherited the disease
• BRCA1 and BRCA2 are implicated in ovarian cancer
  too
• Family history breast cancer

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B. Symptoms of ovarian cancer

• Swelling of the stomach (abdomen) from a buildup
  of fluid
• Unusual vaginal bleeding
• Pelvic pressure, cramps
• Unexplained changes in bowel habits, including
  diarrhea or constipation
• Changes in bladder habits, including a frequent
  need to urinate
• Loss of appetite
• Back or leg pain
• Problems such as persistent gas, bloating,
  long-term stomach pain, or indigestion

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C. Detection

• Often called the silent cancer

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D. Treatment

• How much and what type of surgery depends on how
  far the cancer has spread, general health, and
  whether or not she still hopes to have children
• For LMP tumors
• Unilateral Oophorectomy -
• Bilateral oophorectomy
• Uni/bilateral salpingectomy
• Debulking shrinking of the tumor
• Radical hysterectomy removal of omentum (fat
  pad that surrounds the intestines)
• Radiation and/or chemotherapy

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Stages of ovarian cancer

• Stage I The cancer is contained within the ovary
  (or ovaries).
• Stage II Cancer is in one or both ovaries and
  has spread to other organs in the pelvis, such as
  the bladder, rectum, or uterus.
• Stage III The cancer is in one or both of the
  ovaries and has spread to the lining of the
  abdomen or to the lymph nodes.
• Stage IV This is the most advanced stage. The
  cancer has spread from one (or both) ovaries to
  distant organs, such as the liver or lungs.

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Survival rates after 5 years
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• Medline site http//www.nlm.nih.gov/medlineplus/o
  variancancer.html
• Disease risk questionnaire http//www.yourdiseaser
  isk.harvard.edu/hccpquiz.pl?langenglishfunchome
  quizovarian