Gestational trophoblastic neoplasia overview
Template:Choriocarcinoma Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2]
Overview
In the United States, endometrial cancer is the fourth most common type of cancer among women. Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. Approximately 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. The pathophysiology of endometrial cancer depends on the 7 histological subtype: endometrioid, uterine papillary serous, mucinous, clear cell, squamous cell, mixed and undifferentiated. Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen, obesity, diabetes, high blood pressure and genetic disorders. The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer. Pelvic MRI and endometrial biopsy may be diagnostic of endometrial cancer. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The optimal therapy for endometrial cancer depends on the stage at diagnosis.
Classification
Endometrial cancer may be classified according to histology into 7 subtypes: endometrioid, uterine papillary serous, mucinous, clear cell, squamous cell, mixed, and undifferentiated.
Pathophysiology
Development of endometrial cancer is the result of multiple genetic mutations. Genes involved in the pathogenesis of endometrial cancer include TP53, KRAS, and PTEN. The pathophysiology of endometrial cancer depends on the histological subtype.
Causes
Causes of endometrial cancer include genetic mutations of the KRAS gene, TP53 gene, TP16 gene, and/or PTEN gene. Other genetic mutations have also been described.
Differential Diagnosis
Endometrial cancer in early stage must be differentiated from diseases that cause abnormal uterine bleeding and endometrial thickening on ultrasound, such as endometrial hyperplasia, endometrial polyp, and submucosal uterine leiomyoma. In advanced stages endometrial cancer must be differentiated from uterine sarcoma and uterine lymphoma.
Epidemiology and Demographics
In the United States, endometrial cancer is the fourth most common type of cancer among women.[1] In 2011, the age-adjusted prevalence was approximately 232 per 100,000 and the age-adjusted incidence was approximately 27 per 100,000 in the USA.[2]
Risk Factors
Common risk factors in the development of endometrial cancer are estrogen exposure, tamoxifen use, obesity, diabetes, high blood pressure and genetic disorders.
Screening
There is no standard or routine screening test for endometrial cancer.
Natural History, Complications and Prognosis
If left untreated, approximately 8–30% of patients with atypical endometrial hyperplasia may progress to develop endometrial cancer. Common complications of endometrial cancer include menorrhagia and metastasis. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
Diagnosis
Staging
According to the FIGO Staging System, there are 4 stages of endometrial cancer.
History and Symptoms
The hallmark of endometrial cancer is abnormal vaginal bleeding. A positive history of bleeding between normal periods in premenopausal women and vaginal bleeding and/or spotting in postmenopausal women is suggestive of endometrial cancer.
Chest Xray
Chest radiography (CXR) may be helpful in the diagnosis of pulmonary metastasis of endometrial cancer. The characteristic findings of pulmonary metastasis are peripheral, rounded nodules of variable size scattered throughout both lungs.
CT
Pelvic postcontrast CT scan may be helpful in the diagnosis of endometrial cancer.
MRI
Pelvic MRI may be diagnostic of endometrial cancer. The MRI findings of endometrial cancer vary according to the stage of the disease and may include presence of localized tumor, invasion to surrounding structures, large pelvic nodes in nodal involvement, and tumors of distant metastasis.[3]
Ultrasound
On transvaginal ultrasound, endometrial cancer is characterized by thickening of the endometrium and disruption of a subendometrial halo.
Other Diagnostic Studies
Endometrial biopsy may be diagnostic of endometrial cancer.
Treatment
Medical therapy
The optimal therapy for endometrial cancer depends on the stage at diagnosis. A combination of chemotherapy and radiation therapy is indicated in stages IIIB- IV.
Surgery
The feasibility of surgery depends on the stage of endometrial cancer at diagnosis. Surgery is the mainstay of treatment for endometrial cancer stages I-III.
Primary Prevention
Effective measures for the primary prevention of endometrial cancer include administration of combination oral contraceptives.
Secondary Prevention
The risk of recurrence of endometrial cancer is highest within 2 years. Life-time follow-up is needed, especially within the first 2 years following diagnosis and successful treatment. Routine follow-up visists occur at 3-4 months interval during the first 2 years, at 6 months interval during the next 3 years, and yearly thereafter.
References
- ↑ endometrial cancer statistics. CDC.gov
- ↑ Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
- ↑ "endometrial cancer MRI".