Which is not a part of corpus cancer syndrome? (AIIMS Nov. 2010)
1. Obese hypertensive woman with diabetes mellitus constitutes the corpus cancer syndrome.
2. Endometrial cancer is most common genital cancer in developed countries. In India though cancer cervix is the most common genital cancer. The most type of cancer is adenocarcinoma and in uterus the most common site is the fundus of the uterus. It spreads through lymphatics, but in hematogenous spread it metastasize to peritoneal surface.
3. Diagnosis of Endometrial cancer
a. The most common symptom is abnormal vaginal discharge. A case of post-menopausal bleeding is considered to be due to endometrial carcinoma unless proved otherwise.
b. Most definitive method of diagnosis is fractional curettage, first old endocervix and then of endometrial cavity. If pyometra is detected, fractional curettage is withheld for about one week to avoid perforation and systemic infection.
c. Definitive diagnosis is done by endometrial biopsy but the diagnostic method of choice is fractional curettage.
d. Uterine aspiration cytology is mainly used for screening high risk cases and those on estrogen therapy.
4. High risk females for endometrial cancer
The high risk females for developing endometrial cancer are
a. Females of older age generally postmenopausal females of aged 60 or more.
b. Generally unmarried females or of low parity are at risk, nulliparous (those who haven’t gave birth to a child) are more at risk than multiparous.
c. Females attaining early menarche and late menopause are at larger risk for this cancer.
d. Females with diabetes, hypertension or taking diet rich in fat are at higher risk. This is called Corpus cancer syndrome which consist of obesity, hypertension and diabetes.
e. Familial history has been seen with this cancer.
f. Females having anovulatory cycles.
g. Menopause occured by radiation, female having fibroid uterus or atypical complex endometrial hyperplasia. The later can turn into endometrial cancer in about one third of cases.
i. There are certain drugs like tamoxifen which is supposed to have some potential to cause endometrial cancer.
Largest risk factor for endometrial carcinoma is unopposed estrogen stimulation which may be due to
i. Functional ovarial tumor like Granulosa cell tumor.
ii. Polycystic ovarian syndrome or Stein-Leventhal syndrome, and
iii. Estrogen replacement therapy in post-menopausal women.
5. WHO grading of Endometrial Cancer
World health organization graded this cancer in three grades. The main important thing to know in each grades are
a. Grade I
In this grade there is adenomatous hyperplasia, the most differentiated tumor is called Adenoma malignum. This cancer has the best prognosis as metastasis is rare and 5 year survival rate is more than 90%.
b. Grade II
In this stage the glandular differentiation of endometrial tissues are less distinct as it is interspersed by adenomatous pattern, cell masses are without the proper gland formation.
c. Grade III
The glandular pattern is completely absent and cells becomes anaplastic resembling a sarcoma. This grade has worst prognosis and 5 year survival rate is only 10%.