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Endometrial and Other Cancers in The Menopause PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Endometrial and other cancers in the menopause” by Faustino R. Pérez-López.

This medical PowerPoint presentation is about endometrial and other cancers in the menopause.

Endometrial cancer is a type of cancer that begins in the lining of the uterus, called the endometrium. It is one of the most common types of cancer that occurs in women after menopause. The risk of developing endometrial cancer increases as women age, and the average age at diagnosis is around 60 years old.

Other types of cancers that can occur in menopausal women include ovarian cancer, cervical cancer, and breast cancer. Ovarian cancer occurs in the ovaries, which are located in the pelvis, while cervical cancer occurs in the cervix, the lower part of the uterus that connects to the vagina. Breast cancer can occur in the breast tissue.

The risk of developing these cancers can be influenced by a number of factors, including genetics, lifestyle factors such as smoking and alcohol consumption, and hormonal factors such as the use of hormone replacement therapy (HRT) or oral contraceptives.

Symptoms of endometrial cancer may include abnormal vaginal bleeding, pelvic pain, and pain during sex. Symptoms of ovarian cancer can include abdominal bloating, pelvic pain, and difficulty eating. Symptoms of cervical cancer can include abnormal vaginal bleeding, pelvic pain, and pain during sex. Symptoms of breast cancer can include a lump in the breast, changes in breast size or shape, and nipple discharge.

It is important for menopausal women to have regular check-ups with their healthcare provider and to report any unusual symptoms or changes in their bodies. Screening tests such as mammograms and Pap tests can help detect breast and cervical cancers early, while there is a greater chance for successful treatment.

Tags : Endometrial cancer, menopause, Gynecologic Oncology, Gynecologic Oncology PowerPoint presentation

Published on : May 29, 2023 | Views : 1142 | Downloads : 2

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Slide 1-

Endometrial and other cancers in the menopause Faustino R. Pérez-López University of Zaragoza Faculty of Medicine and Lozano-Blesa University Hostpital, Zaragoza 50009, Spain
Slide 2-

Learning Objectives Recognize the current evidence-based recommendations for women in their second half of life regarding genital cancer risk and diagnosis Describe current general approaches for the management of genital cancer
Slide 3-

Cancer and menopause Menopause is not associated with increased cancer risk However, cancer rates increase with age and cancer is the second leading cause of death in women Special attention should be provided about oncologic issues during the second half of life
Slide 4-

Genetic factors and cancer Genetics may contribute to the risk of various cancers Mass screening for specific mutations cannot be used in the general population There are no clear screening tests for some cancers (endometrial, ovarian, vulvar, lung) Preventive measures are based upon early organ extirpation in genetic mutation carriers
Slide 5-

Lifestyle and cancer: modifiable risk factors Smoking Alcohol High body mass index Dietary factors Physical activity Use of hormones Infertility treatments Hormone contraception Menopause hormone therapy
Slide 6-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 7-

Endometrial cancer It is the most common gynecological cancer It occurs most often in postmenopausal women, with less than 5% diagnosed under 40 years of age There is no effective screening program, but occasionally cervical smears contain endometrial cells or double ultrasound endometrial thickness of 4 mm or more indicating the need for endometrial sampling
Slide 8-

Age Family history of endocrine-related cancers (breast, ovary) Previous breast or ovarian cancer Endometrial hyperplasia in the past Radiation therapy to the pelvis High number of menstrual cycles (early menarche, late menopause) Polycystic ovarian syndrome Nulliparity Infertility or failure of ovulation Unopposed estrogen therapy Tamoxifen treatment Diabetes Obesity Sedentarism Metabolic syndrome Diet high in animal fat Risk factors for endometrial cancer
Slide 9-

Pregnancies Physical activity Use of oral contraceptives Use of IUD Smoking Protective factors for endometrial cancer
Slide 10-

Symptoms of endometrial cancer Non-menstrual bleeding or discharge Especially post-menopausal bleeding Heavy bleeding Dysuria Pain: During intercourse (dyspareunia) Pain and/or mass in pelvic area Back pain Weight loss
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Endometrial cancer diagnosis Pelvic examination Pap smear (may detect cancer spread to cervix) Transvaginal ultrasound Endometrial sampling (hysteroscopy) or curettage is mandatory
Slide 12-

Who needs a biopsy? Postmenopausal bleeding Perimenopausal intermenstrual bleeding Abnormal bleeding with history of anovulation Postmenopausal women with endometrial cells on PAP Thickened endometrial stripe via sonography
Slide 13-

Histopathology Endometrioid adenocarcinoma (70-80%) Clear cell and serous tumor are more aggressive and probably present at a more advances age (8-12%) Adenosquamous (4%) Mucinous (2%) and others
Slide 14-

Type I Estrogen-related Younger and heavier patients Low grade Background of hyperplasia Perimenopausal Exogenous estrogen Type II (~10% of total cases) Aggressive High grade Unfavourable histology Unrelated to estrogen stimulation Occurs in older and thinner women Endometrial cancer: Type I and II Familial/genetic (~15% of total cases) Lynch II syndrome/HNPCC Familial trend HNPCC = Hereditary Non-Polyposis Colon Cancer
Slide 15-

Genetic syndromes: HNPCC (Lynch síndrome) Autosomal dominant inheritance MMR (mismatch repair) mutations hMSH2 (chromosome 2) hMLH1 (chromosome 3) Early age of colon cancer: mean 45 years Endometrial cancer: second most common malignancy 20% cumulative incidence by age 70 Earlier age of onset than sporadic cancer Other: ovary (3.5-8 fold), stomach, pancreas, etc
Slide 16-

Endometrial cancer treatment Surgery Hysterectomy Salpingo-oophorectomy Pelvic lymph node dissection Radiation therapy Hormone therapy: progestogens, antiestrogens Chemotherapy
Slide 17-

Overall results The overall results are better than for cervix carcinoma, not because it is less malignant, yet because treatment is received earlier Postmenopausal bleeding is much more difficult to ignore than the irregular bleeding of younger woman Cancer dissemination seems to be more rapid for cervix carcinoma than for endometrial spread
Slide 18-

Recurrence of endometrial cancer The incidence of recurrence within 5 years is in the range of 20 to 30%, depending on the stage at diagnosis, treatment and individual characteristics The majority recurrences appear within 3 years of treatment. Early recurrence has a poor prognosis
Slide 19-

Progestogens Many endometrial cancers are hormone dependent and progestogens have been used as part of a combined primary treatment as well as for recurrent or metastatic growths Between 15% and 50% recurrences respond to medroxyprogesterone, with or without tamoxifen
Slide 20-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 21-

Uterine sarcoma Accounts for fewer than 10% of all corpus cancers Abnormal vaginal bleeding the most frequent presenting symptoms for all histologic types Types: carcinosarcoma (60%), leiomyosarcoma (30%), endometrial sarcoma (10%), and adenosarcoma (<1%)
Slide 22-

Uterine sarcomas: general characteristics Exposure to radiation may enhance the development of uterine sarcomas (seen mainly in mixed sarcomas) Mean age 65-75 for carcinosarcoma but earlier for leiomyosarcoma and endometrial stroma sarcoma Early hematogenous spread to liver and lung is common In patients without extrauterine disease, 40% chance of distant recurrence
Slide 23-

Uterine sarcomas: management Surgery is the hallmark of treatment with hysterectomy and bilateral salpingo-oophorectomy being the standard For patients with advanced or recurrent disease, aggressive surgical intervention is unlikely to influence outcome Adjuvant radiotherapy has been shown to improve local control, effect on overall survival unknown
Slide 24-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 25-

Ovarian tumors Nearly 25% of all ovarian neoplasms are malignant Approximately 80% are primary malignancies of the ovary 80% of all cases of primary carcinomas of the ovary arise in serous or mucinous cysts The remainder are secondary tumors, usually carcinomas
Slide 26-

Epidemiology of ovarian cancer 9th most common cancer among women 5th most common cause of cancer death 1st most common genital cancer death
Slide 27-

Epithelial ovarian cancer (EOC) Most common type of ovarian cancer Epithelial (75%) Germ cell (15-20%) Sex-cord stromal (5%) Median age of presentation 65 Overall lifetime risk 1 in 70 75-80% of patients are diagnosed with stage III or IV disease
Slide 28-

Ovarian cancer risk factors Age is the most important risk factor Family history (2 or more first degree relatives) Nulliparity Early menarche, late menopause Late childbirth Environmental factors
Slide 29-

Ovarian cancer protective factors Multiparity First pregnancy before age 30 Oral contraceptives Breast feeding Tubal ligation Salpingectomy Hysterectomy Risk reduction oophorectomy
Slide 30-

Hereditary ovarian cancer BRCA1 and BRCA2 mutations Account for 10% of EOC Hereditary non polyposis colorrectal cancer (HNPCC), Lynch II Colorectal cancer before age 50 Endometrial cancer before age 50 Other cancer localizations: ovarian, pancreas, gastric, small bowel, etc
Slide 31-

Epithelial carcinogenesis: ovarian vs the fallopian tubes Ref. Levanon K, Crum C, Drapkin R. New insights into the pathogenesis of serous ovarian cancer and its clinical impact. J Clin Oncol. 2008 Nov 10;26:5284-93.
Slide 32-

Malignant tumor symptoms Lack of any specific symptom, tumors are often large by the time the professional is consulted Menstrual function is seldom upset, and any irregularity is attributed to the patient’s “time of life” Weight gain, abdominal swelling or pressure symptoms Very large tumors may cause respiratory embarrassment and edema or leg varicosities Cachexia due to interference with alimentary function
Slide 33-

General clinical rule An experienced examiner will recognize an ovarian tumor mainly because ovarian tumor is the most likely diagnosis A fluid thrill may be elicited from an ovarian cyst, and ascites and tumor may coexist, but as a rule the distinction should be easily made All abdominal swelling should be subjected to ultrasound and X-ray examination
Slide 34-

Other clinical complications Rupture of a cyst Pseudomyxoma peritonei is a rare condition that follows the rupture of a mucionous tumor. The epithelial cells implant on the peritoneum which is not absorbed, producing abdominal visceral spreading Hydrothorax may accompany ascites due to any cause or as an accompaniment of a lung tumor. Sometimes this conditions is associated with ascites (the so-called Meigs’ syndrome)
Slide 35-

Age: if the patient is > 50 the chance of malignancy is over 50% as opposed to less than 15% in premenopausal. Tumors in childhood are usually malignant Rapid growth Ascites Solid tumors, especially when bilateral Multilocular cysts with solid areas Pain, especially when referred pain suggests malignant involvement of nerve roots Tumor markers, such as CA125, may be measured in the blood, but a normal level does not exclude malignancy Features suggestive of malignancy
Slide 36-

Principles and purpose of ovarian cancer surgery Staging of disease Prognosis and treatment depend upon surgical findings and subsequent stage Debulking (cytoreduction) Overall reduction of tumor burden to less than 1 cm (preferably no gross residual disease) improves survival Palliation of symptoms Goldie-Coldman Hypothesis: resistance to chemotherapy will develop in fraction of remaining viable cells
Slide 37-

Ovarian cancer surgical management
Slide 38-

First-line therapy: Standard treatment options Platinum + Taxane Chemotherapy(Carboplatin + Paclitaxel) Surgery with maximum cytoreduction effort <1 cm residual disease
Slide 39-

Goals of treatment: relapsed ovarian cancer Prolong survival Delay time to progression Control disease-related symptoms Maintain or improve quality of life
Slide 40-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 41-

Cervix cancer and menopause PAP test every 3 years (or every 5 years if combined with HPV test) after a normal report 3 years in a row for women Screening not necessary ≥ age 65 with 3 or more normal PAP tests in a row, no abnormal PAP in past 10 years, or 2 or more negative HPV tests in past 10 years
Slide 42-

Cervical cancer Incidence in Europe 8-12% Associated with Young age at first intercourse Number of sexual partners HPV 16,18, 33 and others Smoking Immunosupression
Slide 43-

Pathology of cervix cancer Peaks 35-44 and 75-85 years Squamous (70%) Adenocarcinoma (12%) Adenosquamous (12%) Direct spread - anatomical
Slide 44-

Clinical features at presentation Abnormal bleeding Postcoital, intermenstrual, postmenopausal bleeding Abnormal smears Advanced disease related with Offensive vaginal discharge Neuropathic pain Renal failure Deep venous thrombosis
Slide 45-

Cervical cancer Microinvasive Cone biopsy, trachelectomy, hysterectomy Invasive Radical hysterectomy, node dissection Radical vaginal hysterectomy, laparoscopic node dissection Chemoradiotherapy
Slide 46-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 47-

Vulvar cancer 3-4% of all gynecologic malignancies The incidence increases with age Longevity Increased prevalence of HPV infections Increased smoking habit
Slide 48-

Vulvar cancer: risk factors Human papillomavirus infection Genital condilomas are detected in 5% of vulvar cancer Vulvar intraepitelial neoplasia (VIN) Medical history Previous squamous cell carcinoma of the cervix or vagina Chronic immunosuppression Smoking
Slide 49-

Vulvar cancer diagnosis Patients do not ask for early consultation Patients consider symptoms as trivial skin conditions Physicians may neglect small skin lesions
Slide 50-

Clinical symptoms Chronic pruritus vulvae Palpable vulvar lesion Asymptomatic: in 20% of patients the lesion is detected during examination for unrelated condition Later the lesion becomes necrotic cauliflower or hard ulcerated Bleeding, watery discharge, superinfection and pain Melanomas frequently appear as bluish black, pigmented, or papillary lesions
Slide 51-

Prevention of vulvar cancer Detection and management of Lichen and VIN Proper management of all cases with pruritus vulvae All vulval lesions should be diagnosed accurately especially those arising during the second half of life All pigmented vulvar lesions should be assessed for biopsy
Slide 52-

Vulvar surgery options Skinning vulvectomy: this is an option for treating extensive VIN Simple vulvectomy Radical vulvectomy
Slide 53-

Vulvar radiotherapy Malignant disease of the vulva is not commonly managed by radiotherapy Postoperative radiotherapy can reduce regional recurrences and inguinal lymph node metastases Chemotherapy as radiation sensitizer can improve response of the malignant tissue
Slide 54-

Vulvar melanoma Rare: incidence 0.1/100,000 women Second most common vulvar malignancy No symptoms (most) Itching, bleeding, groin mass Labia minora, clitoris Vulvar nevi are junctional, precursor lesion to melanomas
Slide 55-

Outline 1. Endometrial cancer 2. Uterine sarcoma 3. Ovarian cancer 4. Cervix cancer 5. Vulvar cancer 6. Other cancers
Slide 56-

Vaginal cancer < 1% of gynecological malignancies Average age at diagnosis is 65 High risk factors HPV infection of the cervix or the vulva Exposure to diethylstilbestrol in utero It might progress to clear cell adenocarcinoma of the vagina and cervix The mean age at diagnosis is 19 years
Slide 57-

Colorectal cancer risk factors Age More than 90% of colorrectal cancer is found in people ages 50 and over Familial history (in a mother, father, brother, sister, or child): Colorectal cancer, adenomatous polyps or “adenomas” Ovarian or endometrial cancer before age 50 Inflammatory colitis and Crohn´s scolitis Smoking, high fat diet, obesity in premenopausal women
Slide 58-

Lung cancer risk and protective factors Incidence and mortality rates begin to increase between the ages 45 and 54 and rise progressively until 75 Median age at diagnosis 70 In the US African-Americans have the highest incidence and mortality In developing countries female cigarette use is low Beneficial micronutrients in fruits and vegetables
Slide 59-

Prevention of lung cancer Cigarette smoking causes 90% of lung cancer deaths Avoid second hand smoking Get you home tested for radon Avoid carcinogens at work