Endometrial cancer

Karcinom endometrija zloćudni je tumor epitela sluznice maternice. Adenokarcinom endometrija (lat. adenocarcinoma endometrii) je najčešći zloćudni tumor ženskoga spolnoga sustava. Tipično se pojavljuje u žena u perimenopauzi i postmenopauzi. Najveći broj pacijentica zahvaćenih ovim karcinomom nalazi se u dobi od 50. - 65. godine života. Incidencija karcinoma endometrija jest u porastu, zbog produženog životnog vijeka, ali i povećane prisutnosti i izloženosti brojnim rizičnim čimbenicima. Glavni čimbenici rizika su debljina,nuliparitet, anovulacije, šećerna bolest. Postoje dva temeljna oblika karcinoma endometrija. Jedni su ovisni o estrogenima, razvijaju se iz područja hiperplazije endometrija, dobro su diferencirani te imaju dobru prognozu. Drugi tip karcinoma su neovisni o estrogenima, javljaju se uglavnom u starijih žena, slabo su diferencirani, prognoza im je znatno lošija nego kod prvog tipa, međutim imaju nisku stopu incidencije. Zlatni standard u dijagnostici ove bolesti jest frakcionirana kiretaža, koja je temelj za postavljanje patohistološke dijagnoze. Ostale dijagnostičke metode su histeroskopija, čije su prednosti egzaktnost i optička kontrola, te ultrazvuk koji služi kao dobro pomoćno sredstvo za potvrdu sumnje na ovu zloćudnu bolest. Od laboratorijskih nalaza koristi se tumorski biljeg CA-125 koji je povišene koncentracije u uznapredovalim stadijima bolesti. Klinički se oko 90% ovih karcinoma očituju krvarenjem, ali samo oko 25% krvarenja u postmenopauzi ujedno znači i karcinom. Najvažniji pokazatelj zloćudnosti tumora je atipičnost stanica u hiperplaziji endometrija. Liječenje ovih pacijentica je u osnovi kirurško, dok se od adjuvantnih postupaka primjenjuju zračenje, hormonska terapija ili polikemoterapija. Ukupno je preživljavanje više od 5 godina u oko 65% bolesnica.Endometrial carcinoma is a malignant tumor of the uterine mucosa epithelium. Endometrial adenocarcinoma (lat. adenocarcinoma endometrii) is the most common malignant tumor of the female genital system. It typically occurs in perimenopausal and postmenopausal women. The largest number of patients affected by this cancer is aged between 50 and 65 years. The incidence of endometrial cancer is increasing, because life span has been extended, but also increased the presence and exposure to various risk factors. The main risk factors are the application of exclusively estrogen replacement therapy, obesity, women who never gave birth, anovulation and diabetes mellitus. There are two basic forms of endometrial cancer. The first type are estrogen dependent, they develop from the area of endometrial hyperplasia, are well differentiated and have a good prognosis. The other type of cancer is independent of estrogen. It mainly occurs in older women, it is poorly differentiated, and their prognosis is significantly worse than in the first type, however, they have a low incidence rate. The gold standard in the diagnosis of this disease is fractional curettage, which is the basis for setting up a pathohistological diagnosis. Other diagnostic methods are hysteroscopy, the advantages of which are exactness and optical control, and ultrasound that serves as a good aid to confirm the suspicion of this malignant disease. From the laboratory findings, CA-125 tumor marker is used. It's elevated concentration indicates a progressive stage of the disease. Clinically, about 90% of these cancers occur with bleeding, but only about 25% of postmenopausal bleeding also means cancer. The most important indicator of tumor malignancy is the atypia of cells in hyperplasia of the endometrium. The treatment of these patients is basically surgical, while adjuvant procedures include radiation, hormone therapy or polychemotherapy. Total survival is over 5 years in about 65% of patients