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Giới thiệu
Endometrial cancer is a malignant tumor of the uterus. This is also
known as uterine cancer, cancer of the corpus uteri, uterine corpus cancer, and
endometrial carcinoma. This is usually diagnosed in its early stages and still
localized, with high survival rates.
Endometrial Cancer_Disease Background 1Dịch tễ học
Endometrial cancer is the sixth most common malignancy worldwide and
the 14th leading cause of cancer death in women worldwide. This is
the most common gynecologic cancer in developed countries and the second most
common in developing countries. This more commonly presents in individuals
>50 years of age or postmenopausal women.
High rates are found in Europe and North America, and low rates are seen
in developing countries. There is increasing risk of endometrial cancer seen
most evidently in some Asian counties (Japan, the Philippines, Singapore and
India), Belarus, Lithuania, Costa Rica and New Zealand. Black females are more
likely to have high-grade tumors and advance disease at the time of diagnosis.
Sinh lý bệnh
Uterine cancer can occur at the inner lining of the uterus (endometrium) or at the muscle layer of the uterus (myometrium). Genetic mutations associated with molecular signaling pathways, and hyperinsulinism that are oftentimes linked to diabetes mellitus and polycystic ovarian syndrome (PCOS) play significant roles in the development of endometrial cancer. Endometrial intraepithelial neoplasia (atypical endometrial hyperplasia) is the precursor lesion to endometrial cancer according to the 1994 World Health Organization (WHO) and International Endometrial Collaborative Group schemas.
Yếu tố nguy cơ
Endometrial Cancer_Disease Background 2The risk factors of endometrial cancer are age ≥55 years; excess estrogen (eg estrogen therapy, estrogen-producing tumors, early menarche, late menopause, Tamoxifen use); obesity or high body mass index; metabolic syndrome (eg hypertension, diabetes mellitus); nulliparity or infertility; polycystic ovarian syndrome (PCOS); patient history of breast and ovarian cancer; genetic mutation (eg hereditary non-polyposis colorectal cancer/Lynch syndrome); family history of endometrial cancer; and smoking.
Phân loại
Types of Endometrial Cancer
Type 1 - Endometrioid (Adenocarcinoma of the Endometrium)
Type 1 endometrioids are more common (75-80% of cases). These are pathogenetically associated with unopposed estrogen stimulation. These are usually low-grade tumors that are diagnosed early, and have a good prognosis. These are grouped into 3 cases based on the degree of differentiation: G1: ≤5% of a nonsquamous or nonmorular solid growth pattern that are well-differentiated; G2: 6-50% of a nonsquamous or nonmorular solid growth pattern that are moderately differentiated; and G3: >50% of a nonsquamous or nonmorular solid growth pattern that are poorly differentiated or undifferentiated.
Type 2 - Non-endometrioid
Examples of type 2 - non-endometrioids are serous, clear cell, undifferentiated/dedifferentiated carcinomas, carcinosarcoma, sarcoma, and malignant-mixed Mullerian tumors. These comprise 10-20% of the incidence rate. These are more aggressive forms of malignant epithelial tumors with an increased incidence of extrauterine disease at presentation and are considered high-risk tumors. These arise from atrophic endometrium and without hormonally associated pathogenesis.
Histology
Papillary serous carcinoma accounts for 10% of cases but comes with high mortality rates (40%). Clear cell histologic type is rare (4%) but with poor prognosis. Grades 1 and 2 tumors are considered low-risk tumors except for serous or clear cell carcinoma. These are well- or moderately differentiated tumors and/or with <50% myometrial invasion depth and/or <2 cm tumors. Grade 3 tumors are considered high-risk tumors. Poorly differentiated tumors and/or with ≥50% myometrial invasion depth and/or ≥2 cm tumors.