Endometrial cancer

Generality

Cancer of the endometrium, or uterine body, originates from the glands of the mucous membrane that lines the body cavity of the uterus. This tumor is now the most frequent of the genital tract. Mortality from cancer of the endometrium is, however, considerably lower than that from cancer of the ovary and cervix.

Endometrial cancer occurs mainly in the age group between 55 and 65 years (average age 61 years) and only in 20% of cases before menopause has begun. It is rare (3-5% of cases). ) before the fourth decade of life. In recent years it seems that the disease continues to be more frequent in the post-menopause, but has become rarer under the age of 55. The incidence varies widely from country to country; currently, in Italy, about 10 invasive endometrial cancers occur every year for every 100,000 women.

1) VAGINA 2) NECK OF THE UTERUS 3) UTERUS 4) PALLOPIUS TUBE 5) OVARY 6) FIMBRIA

The uterus is the female reproductive organ. It has a characteristic funnel shape with the neck (cervix) facing down. This opening communicates with the vaginal canal which opens outwards with the labia minora.
The walls of the uterus are made up of two layers, an external glandular one (endometrium) and an internal muscular one (myometrium).

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Risk factors

Women at risk for endometrial cancer have some characteristics that often recur:

obesity;
late menopause or an early menarche;
polycystic ovary syndrome (with increased estrogen and cycles without ovulation);
use, for long periods, of estrogens not associated with progesterone (estrogens have a proliferative stimulus against the glandular mucosa of the "endometrium which, in excessive conditions, can lead to cancer);
prolonged use (for years) of tamoxifen in patients who have had breast cancer;
diabetes;
hypertension;
nulliparity (not having had children);
chronic diseases of the liver and biliary tract;
presence of tumors of the ovary that produce estrogen in large quantities;
Lynch syndrome type II (family syndrome in which tumors of various kinds occur very frequently, especially in the colon and endometrium).

However, the most significant risk is represented by the first four conditions.

Types of endometrial cancer

This tumor can arise anywhere in the body cavity of the uterus and can occur in two forms: a circumscribed and a diffuse one.

Circumscribed tumor

The circumscribed form usually appears as a polyp or, more rarely, as an ulceration or nodule. The tumor can infiltrate the myometrium (the uterine layer under the endometrium) deeply and thus cause progressive erosion of muscle thickness up to the peritoneum.

Diffuse tumors

The diffuse form usually occupies most of the uterine cavity and is usually due to the extension of a circumscribed form, but in some cases it may also be due to a multicentric origin (in several points at the same time) of the tumor. The infiltration of the myometrium is less frequent in the diffuse and / or proliferative forms than in the ulcerative ones.
The uterus usually has an increased volume and decreased consistency; however, it may also appear completely normal.

Severity of the tumor

In the context of endometrial cancer, also called adenocarcinoma because it originates from a glandular component, there are different degrees of differentiation (alteration) of the cells that compose it. The degree of differentiation is very important in order to be able to elaborate a prognosis, therefore also in order to be able to evaluate the most appropriate type of therapy.

According to the most used classification, called FIGO, the grades of endometrial cancer are 3: G1, G2, G3. Clearly, G1 tumors have the best prognosis.

In grade G1 the adenocarcinoma is formed by glands similar to the normal ones, but more tortuous and complex. It must be differentiated, since it tends to resemble us, from endometrial polyps, from endometrial hyperplasia and from chronic inflammation of the endometrium. .
In grade G2 there is a less marked differentiation (ie the tumor glands resemble much less to the healthy ones, and are therefore called "atypical").
In grade G3 the tumor glandular structures are bizarre and are sometimes not well defined as such. Hemorrhages and areas of cell death are more frequent and the tumor is called undifferentiated adenocarcinoma at this stage.