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6 - CARCINOMA OF THE ENDOMETRIUM Wen Di M.D Ph.D 20031027 1...

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2003-10-27 Carcinoma of the Endometrium 1 CARCINOMA OF THE ENDOMETRIUM Wen Di , M.D. Ph.D
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2003-10-27 Carcinoma of the Endometrium 2      One of the commonest gynecological cancers especially in white Americans it occurs most often in postmenopausal women up to 80 of cases with less than 5 diagnosed under 40 years of age
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2003-10-27 Carcinoma of the Endometrium 3 There is no effective screening programme but occasionally cervical smears contain endometrial cancer cells or double thickness endometrial ultrasonic thickness of 4mm or more indicates a need for endometrial sampling
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2003-10-27 Carcinoma of the Endometrium 4 Risk Factors     The actual cause of this cancer is unknown    Estrogen        given estrogen alone as postmenopausal hormone  replacement therapy        Estrogen secreting tumors of the ovary are  associated with an increased incidence of endometrial  carcinoma
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2003-10-27 Carcinoma of the Endometrium 5           There can be no doubt that oestrogen can alter the  behaviour of this tumour but there is still a question about  oestrogen as a primary causal agent          Approximately 75 of cases of endometrial cancer occur  in the postmenopausal period when estrogen values are low  and progesterone is absent Nulliparity and PCO  syndrome with defective progesterone synthesis carry an  increased risk
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2003-10-27 Carcinoma of the Endometrium 6    Only a proportion of obese diabetic and hypertensive  women develop endometrial cancer and similarly only a  proportion of women with endometrial cancer are obese diabetic or hypertensive The question remains whether  estrogen is a  causal agent or is acting in its normal  capacity as a  growth factor  and is really to be regarded as  a co carcinogen
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2003-10-27 Carcinoma of the Endometrium 7
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2003-10-27 Carcinoma of the Endometrium 8    Oral contraception especially after long term  use reduces the incidence of both endometrial  and ovarian carcinomas
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2003-10-27 Carcinoma of the Endometrium 9    The endometrial hyperplasia induced by Tamoxifen  produces endometrial polyps A report in the  Lancet in 1999 suggested a four-fold increase in  endometrial carcinoma ..
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2003-10-27 Carcinoma of the Endometrium 10 Symptomatology The usual presenting symptom of endometrial carcinoma is  postmenopausal bleeding  which carries a  10 risk of associated malignancy in the absence of  hormone replacement therapy. Curettage or endometrial  sampling is mandatory.  Postmenopausal discharge  from pyometra carries a 50 risk of  associated malignancy.  Pain  may occur with pyometra  or metastatic spread
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