Endometrial cancer
Endometrial carcinoma, and uterine or endometrial cancer (Latin carcinoma corporis uteri ) is a cancer of the uterine lining.
Histology
Histologically, in 85 % of cases were adenocarcinomas of the uterine lining (endometrium). Rare types include serous and clear cell adenocarcinomas or squamous cell carcinomas. The degree of dedifferentiation ( degeneration ) of the cancer cells with G1 ( well differentiated, very similar to the normal tissue ) given to G3. Many cancers express on the cell surface estrogen - and progesterone - receptor molecules.
Staging
The classification of FIGO and the UICC are identical, it is based as in other solid cancers in the TNM system.
- Example: stage IA ( FIGO ) = T1a (UICC ) = tumor limited to the mucosa.
The chances of recovery depend on: for example, 90 % in stage IA, 30 % in stage III. Undifferentiated tumors are less curable than highly differentiated.
Stages according to TNM classification and FIGO ( International Federation of Gynaecology et d' Obstétrique ):
Occurrence
Affected predominantly (about 66-85 % depending on the source) are in menopausal women after menopause. 5 % are under 40, the incidence is in Western countries at about twice the cervical cancer. In Germany, more than 11,000 new diagnoses were asked in 2002. The incidence rate per year has increased in recent years and currently stands at 25:100.000 women.
Causes
It is believed that long-standing elevated estrogen levels promote tumor formation; eg wear women with menstrual disorders, menopause later or hormone replacement therapy have a higher risk than the average population. The diseases of civilization obesity, hypertension and diabetes mellitus II increase the risk of tumors. It is known that obesity increases estrogen production. Whether the risk of phytoestrogens ( estrogen-like substances in foods ) there has not been clarified so far. Secured is that hormone therapy increased the risk only with estrogens.
Causes for hereditary susceptibility to endometrial cancer include mutations in genes encoding DNA mismatch repair proteins.
Symptoms and Diagnosis
Early cancers can rarely be noticed in the context of screening. For the tumor makes early manifested by bleeding. A bleeding after the onset of menopause is therefore always suspect, as well as irregular bleeding and flesh -colored water discharge. 75 % of all endometrial carcinomas are detected in the first stage. The 5-year survival rate is at 90 %. Abdominal pain mean almost always a far advanced, inoperable tumor. The diagnosis is confirmed by a curettage of the uterus ( uterine curettage ).
Treatment
Whenever possible, corpus carcinoma should be surgically removed. The default operation is carried out by means of lower abdominal longitudinal incision or laparoscopy, and at least a total hysterectomy and removal of ovaries and fallopian tubes on both sides. Depending on the stage, among other things, Splenic least the uterus close to half of the uterine connective tissue, the entrainment of a vaginal cuff, the exposure of both ureters and the removal of lymph nodes in the pelvis ( pelvic lymphadenectomy ) and along the abdominal aorta until the disposal of the renal arteries ( para-aortic lymphadenectomy ) in addition be required ( radical hysterectomy according to Piver II / III and Wertheim - Meigs operation). Higher stages should then receive radiotherapy. Inoperable tumors are only irradiated. In papillary serous and clear cell endometrial cancer adjuvant chemotherapy is applied recently.
Forecast
The prognosis of the most common type of endometrioid adenocarcinoma is, with a mortality, ie, the risk of dying from the disease by 6% relatively well. For the other species varies mortality between 21% and 51%. As with all tumors also deteriorates a lack of differentiation of the cells, i.e., a large change in the glandular cells of the original, the prognosis. On average, 80 % of patients survive five years after diagnosis. In Stage I, there are even 90 % in stage II 83%, stage III 43%. After two years, a relapse, so re-growth of tumor cells unlikely. However, for the rest of life remains an increased risk of developing breast cancer.