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Endometrial Cancer and Hyperplasia for USMLE
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- Опубліковано 19 бер 2015
- Endometrial Hyperplasia there is proliferation of the endometrium which becomes very thick. Primarily the hormonal trigger for endometrial proliferation is estrogen. The hormone that blocks the effects of estrogen on endometrium is progesterone.
ETIOLOGY
Obesity can cause this because there is increased aromatase which converts more testoserone to estrogen. Polycystic Ovarian Syndrome (PCOS) which has a high estrogen and testosterone and there is no ovulation and therefore there is no corpus luteum and therefore no progesterone. Tumors that release estrogen releasing. Hormone replacement therapy in post menopausal women.
Two types of hyperplasia, simple and complex. Normally there is small amounts of gland and lots of stromal tissue. In simple there are more glands, but not touching each other. In complex the glands are touching each other. In Atypia there are abnormal nucleus which is really large and it is a very bad sign. Complex atypia has a 30% chance of become endometrial cancer.
Sign and symptoms is abnormal heavy bleeding due to lack of ovulation. Diagnosis is done initially by doing a transvaginal ultrasound looking for endometrial thickness. If less than 5mm than 95% can rule out endometrial hyperplasia. Biopsy is done with a pipelle, however it can miss areas of cancer because small sample. Dilation and curretage and hysteroscopy. Treatment depends on the pathology report. If there is no atypia you can give mirena and MPA which causes enodmetrium to go back to normal. Atypia requires hysterectomy. Type 1 endometrial cancer is endometroid adenocarcinoma.
Endometrial Carcinoma
Most common gyne cancer in women, especially in post menopausal. Type 1: Endometroid Adenocarinoma, due to estrogen secondary to endometrial hyperplasia. Type 2 is clear cell, serous carcinoma and there is no precursor, no precursor, more agressive and occurs much later (70s and 80s). Risk Factors related to unopposed estrogen. Risk factors are Cancers (Breast, Ovarian, Colon Cancer). Obesity, Late Menopause, Diabestes Mellitus, HTN, Nulliparity, Unopposed Estrogen due anovulation, Hormone replacement and tamoxifen. However, COC is protective.
Signs and Symptoms in type 1 is postmenopausal bleeding. In type 2 there is bloating, bowel dysfunction, pelvic pressure. Staging is done by direct extension myometrium, serosa, bladder and large bowel. Or down cervix and vagina and finally fallopian tube. Lympahtic spread can go to pelvic para-aortic lymph nodes. Fallopian tube and into peritoneum. Hematogenous spread is liver and lungs. Stage 1 is when only in uterus. Stage 2 goes into cervix Stage 3 is when it goes into adjacent strucutres. Stage 4 is beyond pelvic cavity.
Investigations are Transvaginal Ultrasound, Biopsy with pipelle, Dilation and curretage, and hysteroscopy. Treatment depends on staging, surgery of hysterectomy with bilateral salpingo-oopherectomy (BSO), pelvic wash and lymph nodes. Omentectomy and this can be done laparoscopy. If there is metastasis then also do chemotherapy and if it recurs than perform radiation therapy
I had endometrial cancer at age 21. Took Megace 1000mg day. After 3 d&c’s and medicine dosage adjustments, I decided I was done. Had a LAVH, left my ovaries alone. I was pcos at the time. Pcos subsided. 43 and period free for 21 years. Best of luck to all the ladies dealing with this.
THANK YOU
Can you tell me if you had excessive watery discharge
@@stephaniebaldwin5926 I experienced watery discharge a couple of days again. The only thing I could compare it to was the same consistency as when my waters broke when I was in labour with both my children. It made my trousers wet
@@zaraart2474 I have the same going on but the doctors are ignoring me.
My girlfriend is 21, and in the same situation as you. She told me that she might not be able to have children. Was the the case with yourself? How are you doing now?
I have endometrial hyperplasia and this is the best explanation way better than my consultant does.
Whats the thinkness?
My thickness is 30mm
Fifty years ago, both my mother and her sister had Endometrioid Cancer, both were in their early fifties at the time, and went on to live well into their eighties in good health. I managed to be cancer free until a recent diagnosis of Endometriod Cancer grade 1, though had felt unwell for a long time. The diagnosis is actually a relief to me, because now, I know the cause, and can deal with it. I will be 74 next week, and my hysterectomy is scheduled for two weeks from now. I am grateful to be going to the #1 Cancer center in the State, which is #2 in the US, and my Gyn Oncologist is an Assistant Professor, so I feel in good hands. She and my Gyn are both kind, compassionate, skilled and highly educated women, so I feel safe with both of them. I feel confident this 'glitch in the road of life', will soon be in the past, and I will continue to focus on living a full and productive life. I have already decided I am not interested in either Chemo or Radiation Therapy. And, just read a very interesting book called, 'Radical Remmission' by Kelly A. Turner, PhD, and plan to incorporate most of her findings into my own life. For years, I have eaten a Plant-based, high fiber, low protein diet, and focus on organic and non GMOs and very little sugar. Buddhist ideas have proven very helpful in calming my mind, and allow me to move forwards with a sense of peace and contentment, by living in the present. Best wishes to any ladies having to go through this. You can do it!
My aunt was diagnosed with type 2 endometrial serous carcinoma in November. She had a hysterectomy in December and, unfortunately they found tumor cells on her pelvic and periaortic lymph nodes. The surgeon said that the lymph nodes were “too sticky with tumor cells to remove.” So, after her five hour surgery my aunt was left with cancer still inside her body. She had a port placed yesterday in the OR and is preparing to start chemo in a couple weeks, Taxol and Carboplatin.
Thank you for this video. It’s very hard to find information about uterine serous carcinoma and you explain in a way that is clear and makes sense.
How is she now?
Wonderful explanations of the Uterus Cancer I have been diagnosed with Endometriosis Cancer . I'm 56 have had 7 kids lots of bleeding & cramping over 30 years . This year finally in Jan. This Doctor saw a Mass Now I'm at The M.D.Anderson Cancer Hospital about to get a hysterectomy Thank God.🙏🙏🙏🙏
Hypothyroid can make people have heavy periods and thickening of the endometrial lining. Have you had hypothyroid prior?
BigMommaSharingtheLove Love i hope you’re doing well!!
you can contact Dr Ahmad Ali , he heal me from my 4 years cancer reach him through his whatsapp number +2348034811617 or his gmail @ Drahmadremedies@gmail.com . believe me he have the medicine to cure you for your cancer
Very explanatory, easy to follow. Not wordy. Right to the point
Goodness gracious. I have every single one of these symptoms, except for heavy bleeding and being post menopausal. I’m 23.
Since I don’t get my period, I had a biopsy done, they had to do it THREE different times the same day because they weren’t getting enough tissue, results came back normal BUT I was sent to have an ultrasound and CT scan and was informed that I have endometrial hyperplasia, a tumor in my uterus and a dermoid cyst on my right ovary. My doctors aren’t giving me any information and I’m so grateful for this video because I just learned way more than what my doctors have told me.
This is the best explanation.
alex Thank You
I agree. Thank you so much for explaining. :)
Really wish there was more PRE menopausal information and videos done. Most of what I can find is all post.
This my case been bleeding for 18 days at first and next more than 2 months straight and it's getting heavy, and it result to anemia, my hemoglobin goes so low and i went to blood transfusion, I've done all the test .. Just waiting for the result of biopsy. My sister died for ovarian cancer..
my doctor told me when they got the first biopsy result it has a low risk of cancer.. But still I undergo to d & c hysteroscopy and got a Merina and still waiting for the result of another biopsy. Hope and pray that it's not cancerous. Thanks for this video its really helpful for me for me how was my situation right now. You've explained it well.
Mylene C. Ano-os (mcsoona) how are you my dear? How did the test go? I’m sorry to hear of the loss of your sister. My
Mother died with uterine and it spread everywhere. She was my best friend. I miss her so much! It’s been 10 years this May 3rd. I hope I find you well!
Blessings 💜
It's leimyoma,fibroids
Great video! However, for endometrial carcinoma type 2 there is a precursor and it is the endometrial intraepithelial neoplasia, This cancer appear to progress from an atrophic endometrium to the precursor lesion, endometrial glandular dysplasia
Andrea Méndez Thanks for the clarification.
Excellent presentation. I feel quite prepared now for my GYN visit next week.
Great explanation. I've learned so much more about endometrial cancer - which I had in 2016 in my 30s
How are you now ?
Thank you for sharing your excellent informational presentation with us. It was simple and easy to understand.
This is the best explanation I have seen. Thank you.
Excellent video Learned so much! Simple terms clear and very educational!
I try my best. Glad you are benefiting.
wow thank you so much for the education ..presented well and professionally. look forward to other videos
Very well explained and easy to understand. Thanks for this video
Thank you so much for the video. Our text is so complicated. And it was quite difficult to follow too. Thank you for this wonderful experience ❤️
That was really great explanation! Thank you and good luck!!
Excellent presentation!
Very thorough conversation, thank you!
Thank you for explaining this so clearly and in depth.
Glad you enjoyed it!
So you mentioned DM as a risk factor and I learned it’s because excess insulin in the blood and LH luteinizing hormone contributes to the formation of testosterone in PCOS (which is a whole other diagnosis) so I’m thinking this excess testosterone is converted to more estrogen or an estrogen precursor. What do you think?
you always make studying way easier, thank you sir
Haya Abdulla Very nice to hear that. Your very welcome.
using them for my obs/gyn revision good work!!
The portion of the uterus that you highlighted in the beginning is not the endometrium. That is the perimetrium. The endometrium is the inner lining of the uterus.
Good presentation.
After my hysterectomy with tubes and ovaries removed. I was diagnosed with low grade 1 uterine cancer. There’s so many terms. Grade and stages. Are they the same?? . It was 3 millimetres in. I had no symptoms. My dr sent me for a biopsy. I am 52, was still getting my period. I was told this diagnosis was good news ?
Any feedback would be appreciated.
Could you please help me understand the following pathology report?
I am 57, postmenopausal. Last period was 8 years ago, no problems until August, 2019 when I noticed occasional spotting. I've had a fibroid for 13 years that did not cause any problems. Transvaginal ultrasound detected thickened endometrium 13.5 mm and a polyp 1 cm. After hysteroscopy, D & C and polypectomy, removed polyp came back positive for FIGO 1 endometrial adenocarcinoma. Total laparoscopic hysterectomy and BSO was performed 3 weeks ago.
Pathology report diagnosis is:
depth of myometrial invasion in Millimeters - 1,
percentage of Myometrial invasion - 7 %,
leiomyomata negative for lymphovascular involvement,
margins are clear,
Fallopian tubes and ovaries are unremarkable,
pathology staging PT1A NXNX.
Thank you.
How are you?
the best explanation .Thanks
Glad you benefited
I have all the symptoms, i got a vaginal ultrasound that showed by endometrial thickness was 25mm so i got sent to get a biopsy & my results say ( ENDOMETRIUM:
PROLIFERATIVE PHASE ENDOMETRIUM, NEGATIVE FOR HYPERPLASIA AND/OR
MALIGNANCY. NOTE: THE IMMUNOSTAIN FOR CD138 IS POSITIVE, FINDING SUPPORTS THE ABOVE DIAGNOSIS. 0 CD138 POSITIVE CELLS ) i have yet to talk to my doctor about results .idk what my results mean but i think they came back negative for anything.
amazing lecture. thanks a ton! ill subscribe to you! hope to see lots of good stuff ..
It was really helpful ,thanks a lot 🤓
Tx for endometrial hyperplasia---> hysterectomy
good lecture thank you so much
I have been diagnosed with stage 1 endometrial cancer. My hysterectomy is scheduled. But what is the cause of the pelvic pain? I am on ibuprofen 24/7. Will the hysterectomy stop the pain as well as the bleeding?
Hi there hope you are doing well, it's been a while since ypu posted.. I'm getting the surgery soon and curious if your pain diminished or resolved? Thanks 🧡
@@Katie-vy5rd Only the surgical pain lingered for about a week. However, since no scans were done prior to surgery, I had already metastasized with tumors in my colon and lymph system which went undetected. 6 mos later they were found on a CT scan which meant I was in stage 3. I did chemotherapy and maintained therapeutic ketosis (Dr. Thomas Seyfried) and RESOLVED them. But I then underwent Keytruda immunotherapy to address a remnant of cancerous cells on my vaginal cuff. It failed and destroyed my thyroid. I started another chemotherapy drug but was informed last week none is available on Oahu. 🏝🌋🌊 So I am at a standstill as to completing the course of infusions. But my CA-125 test is now down to 9. This is the test for female cancer. Anything below 32 is normal. But without another CT scan I will not know if this round of chemo has Resolved the remnant tumor. 🤪
If you have fibroids can that influence a build up the lining
Having PCOS you can still ovulate, many women with PCOS, including myself obviously had to ovulate in order to have our children. Yes there is LESS ovulation, but you doctors need to stop saying "no ovulation" its malpractice. We can still ovulate.
I've been diagnosed with complexed endometriosis with a : Pituitary brain tumour, pre cervical cancer cells & other diseases. Hormone treatment has not worked increased : Bleeding in both parts of pelvic area with neurological complications too. Been referred to neurology, gastroenterology & gynecology. Tbh I'm now more worried it's metastases.
Amber Manning - thinking of you. I know it's been 3 years since you left this comment, yet I am wondering how you are doing. 🦋👼🕯✨️🙏💙
I have complex endometrial hyperplasia with atypia going to levine cancer on the 18th....nervous as I have pcos also and diabetes. good explanation on this video! also family history of ovarian cancer.
ChAllEnGeRGirL Laiweneek how r u now
I am doing better since my complete hysterectomy sucks that I am only 31 and had to have it..but thank u for checking on me! go for 3 months checkup soon!
ChAllEnGeRGirL Laiweneek ok ☺ im 28 n today i had a hyperscopy n d&c, they found abnormal growths in my uterus, the dr said it wasnt a polyp
i have my path report coming in on dec 23rd
im afraid it till be hyperplasia
so with atypial hyperplasia u were able to remove the uterus? even though it wasnt cancer?
mine was cancer unfortunately with atypical hyperplasia, I had my uterus cervix and fallopian tubes removed only thing they kept in was my ovaries. I go for 3 months checkup from surgery soon. then if all is well that visit and no more cancer lurking around then I do a 6 months survivors visit at levine cancer Institute. I hope everything goes well for you hun. I really do. keep me informed and I will try to help you anyway I can. based on the things I've been thru. praying for you!
just hyperplasia isn't as bad as atypical hyperplasia. so if you are lucky it could be fibroids....never know be sure they throughly examine u. I didn't have a choice but to have a complete hysterectomy because mine was cancer
so if yours isn't cancer seriously consider before u make the decision to have a hysterectomy if they give that option
very helpful video, thanks :)
+rafal8921 Your Welcome
Need to review the staging of endometrial ca. Confinement to the endometrial layer (what you refer to as stage 1a) is actually endometrial intra epithelial neoplasia. Stage 1 is sub graded to 1a and 1b based on depth of invasion.
Good job
I appreciate the video - thank you!
Well done. Thank you
Thank you!
thank you so much im suffering of this hyperplasia and i cant not have babies hope this will help to find another pathway to my problem!!!!! Merci beaucoup
Thank you. this was very helpful.
my mom has cistic hyperplasia.. what does that mean.. can someone pls explain
I am 52 yrs old, I had a uterus biopsy and was diagnosed with " Complex hyperplasia with atypia" in 10/2015 (pre-cancerous cells). I am having a total hysterectomy scheduled 12/2015. My father died from pancreas cancer, mother died from lung cancer, sister 32 yrs old died from colon cancer. Should I have my ovaries and cervix removed also ? Do I still get uterus cancer in the future even after I had a hysterectomy ? I am very worry, any feedback is greatly appreciated.
+Mang Cut Sorry to hear about your diagnosis. The question whether or not to have your cervix and ovaries removed will depend on the staging of the cancer and how far it has gone. Your should make that decision with your doctor. If you get a hysterectomy it will be impossible to get uterus cancer, since your entire uterus will be removed. If it has metastasized than it can come up somewhere else, but again that depends on the stage. Usually if it has already metastasized they will not opt for surgery, so it is a good chance it hasn't. Again be sure to ask you doctor about it. Hope everything goes well and you become fully cured of this disease. Our prayers will be with you.
+Mang Cut i agreed with @the study spot, but it seems that your family history for cancer is so strong that iwould suggest that genetic studies should be performed to rule out of course a genetic cause such BRCA mutation or P53 thus an accurate decision could be done!
I want to see this doctor
Great video!!!
I have simple without atypia. I started spotting and bleeding heavey and nonstop for two years before I was diagnosed. I'm surprised it didn't advanced to other things since it took so long. I wonder what my chances are now of getting pregnet I'm only 27.
alex There are treatment options available where you can retain fertility, however, you should discuss more with a doctor on whether that is the best choice for you.
I agree my friend had her egg frozen and her best friends friend carried her baby for her. But I will always say, there are so many children in this world that would love to have parents... just in case... if you cannot have your own, you can have a choice of a boy or girl and you can change a life! Or lives... Sending positive energy your way my dear.
My uterus line is 3cm
Just found out, no symptoms ever
Clear explanation
I had abnormal bleeding so my OB did uterine ablation in march. It is now December, started having severe pelvic,lower back pain and it is now migrating down my legs causing muscle spasms. When I to the ER in November my endometrial stripe was 8mm I went again on the 11th of this month and it is now 1.5cm. But since I had the uterine ablation I no longer bleed. Could I still have this.?
Hi. Please go to your gyne and get a biopsy. And don’t worry so much because biopsy is tolerable and the key is to just relax. I wish you good luck.
You are amazing💕😍
excellent job done
Thanks, Appreciate it!
I know this video is old. I'm 28 years old. I have 30mm thickening on my endometrium. I have no period, not pregnant. Terrible cramps and back pain. increased discharge. My D&C is in 3 days. Any one go through this at my age? any tips?
Thank you so much you made my day
Dx with PCOS put on Metformin due to cyst found. GYN says my testosterone should be elevated but it’s not to be PCOS. My Endometrium is at 20-24mm but she thinks after doing a biopsy today that there may be polyp within the thickening because it was difficult to get a biopsy. I had thyroid cancer 3 years ago and recently polyps found in my colon and stomach. Overall, Im not feeling like it’s benign. Ever heard of polyps hiding out in the endometrium?
This video is fantastic :)
Nice
Should I be concerned if the pills did not work
Great work ! Keep it up ! :)
+Lighto Yagami Thank You!
thank you so much
I was diagnosed with complex endometrial hyperplasia with atypia after 5 years of infertility. For now we are trying to save my fertility using megestrol. I have to have 2 biopsies 3 months apart if those come back good then she will allow 6 months to try to get pregnant. My Dr said no matter what I will have to have a hysterectomy, either after those 6 months of ttc are done or after I have a baby if I was able to conceive.
What I don't understand is why I have to have a radical hysterectomy.... Doesn't that seem a bit extreme?
ci eu cuz it's COMPLEX endometrial hyperplasia with ATYPIA ....or.maybe even your stage is too advanced
So what happened ?
They can store your eggs in egg bank u can have your own baby through surrogacy
Thank you very much!
Your welcome!
I am 30lbs past my normal weight. I'm looking to do exercise and possibly laser lipo. Would this help reduce the estrogen since fat cells have lots of estrogen .???
my mother is 53 years old..post menopause she has endometrial thickness of 5mm in TVS and 7mm in abdominal scan.Is it dangerous
i had complex atypical hyperplasia and adenocarcinoma too in my endo biopsy i didnt go into menopause until 56 and im diabetic mom had ovairian
my mom had ovarian cancer
its amazing ,thank you ...
gabrielalfa Your Welcome!
I was told i had complex hyperplasia with pipelle biopsy but when i had a second biopsy during hysterocopy was told no complex hyperplasia. can complex hyperplasia go back to normal?
Yes, I am not sure how common it is for that to occur, but it does occur. And I am very happy to hear that it occured for you.
Thank you however i have all other symptoms so what are they chances of this happening? Also could it have been a case of the sample may not have contained the complex cells?
I just found out 4 days ago that the lining of the uterus is 20mm :(
Should I be concerned??
My lining is at 8..so 20 is bad..my gynecologist is doing a hysteroscopy soon to visualize the issue. Let me know what they found.
Yeah you need to see a gynecologist, I jst found out that mine si 11.0mm and i was told it's not good
Are you an OBGYN?
Where?
Great explanation.
Going for a doppler ultrasound soon.
Visit at OB showed lining at 9mm. Exam caused some bleeding. Office Usound also revealed a small cyst on left ovary. In menopause 1.5 years and have not spotted until recent exam 4 days ago. Still am spotting. No prior symptom. Am on zero meds for anything. Am not obese. Am 55.6 years old. Crossing my finger that I have nothing serious.
Who has endometrial cancer?
how long does it take for a uterus exposed to estrogen to become effected with endometerial hyperplasia?
Depends on your body weight. Depends on how long you take Estrogen only HRT. A year on Estrogen only can reek havoc.
my doctor gave me a combimation estogen and progesterone. it is the 3rd day i have been taking it but seems like my bleeding stopped even though it was 11mm right before they checked. i thought the hormones are supposed to help me bleed it out. should i be worried?
Not sure what to make of your symptoms. You should go and see the doctor that prescribed it for further evaluation.
Can progesterone suppositories taken in the luteal phase reduce this? I'm at cycle day 1 , my lining is at 11mm.
you can contact Dr Ahmad Ali ,I think he have the answer to this question @ drahmadremedies@gmail.com
when he said chemo it was all over
Are you egyptian?
Can someone tell me this doctors name so I can go see him
Luo Dong. Search on UA-cam
nicely explained...thanks
it is ovarian tumer classification not endometrium please check it
1.endometrial gland = endometrial polyps and endometrial carcinoma.
2.Endometrial stroma =stromal carcinoma.
u discuss about serous adenocarcinoma and endometrinoid carcinoma it is a part of ovarian germinal epithelium tumer... not endometrium... please check it...
I discussed serous and clear cell in the context of Type 2 Endometrial Carcinoma. This is found in BOTH ovarian and Type 2 Endometrial Carcinoma.
Reference: Williams Gynecology 2nd edition, Chapter 33, Subsection: Endometrial Cancer, Sub-subsection: Pathogenesis, first paragraph.
Ok friend... I Will .. Thank u for ur attention... Nice work.
Only a 5 year survival rate 🥺
Even after hysterectomy ?
do you have an email? i have questions about certain things that i am not sure if i was rushed into things by my gynaecology and misled or i misunderstood so could pls send me your email pls