Uterine & Ovarian Cancer

1. 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

2. 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.

3. A. Atypical Hyperplasia = abnormal tissue growth • simple hyperplasia without atypia = a proliferation of cells, but the basic structure of the endometrium is relatively unchanged • 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.   • Hyperplasia with atypia = precancerous, Approximately 25-30% of hyperplasia in this category will progress to endometrial cancer.

4. B. From hyperplasia to endometrial cancer

6. 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.

7. D. What causes endometrial cancer?

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

9. 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

10. 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.

11. G. Detection • Transvaginal ultrasound • Hysteroscope

12. 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.

13. 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)

15. H. Treatment • Treatment of hyperplasia without atypia

16. 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

17. 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.

18. Survival rates • 5 year survival rates for endometrial cancer by stage are:

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

20. 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)

21. 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.

22. 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 –

23. 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. • <10% of women found to have ovarian cancer have inherited the disease • BRCA1 and BRCA2 are implicated in ovarian cancer too • Family history breast cancer

24. 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

25. C. Detection • Often called the “silent cancer”

26. 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

27. 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.

28. Survival rates after 5 years

29. Medline site: http://www.nlm.nih.gov/medlineplus/ovariancancer.html • Disease risk questionnaire http://www.yourdiseaserisk.harvard.edu/hccpquiz.pl?lang=english&func=home&quiz=ovarian