Endometrial Carcinoma (Endometrial Hyperplasia's, Staging Of Ca Endometrium)
Feb 22, 2023
Endometrial carcinoma is the most common gynecologic malignancy and is responsible for a significant number of cancer-related deaths in women worldwide.
Early detection of endometrial carcinoma is crucial for effective treatment and improved outcomes. NEET PG exam tests a candidate's knowledge of the different diagnostic modalities and management options available for this condition.
Anovulatory conditions → PCOD: persistent high Estrogen
Obesity: Fats (1.5-2.5 times more likely)
Corpus cancer syndrome (Corpus= uterine body)
DM – HTN – Obesity
Abnormal liver function tests: altered estrogen metabolism
LYNCH II: HNPCC (Hereditary Non-Polyposis Colon Cancer): 40% association with Ca endometrium
Familial predisposition
1st degree female relatives can have either of these (even 2nd degree are predisposed)
Ca Breast
Ca Endometrium
Ca Ovary
Nulliparous woman: no break from Estrogen exposure. Each pregnancy gives around a 2 year break from menstruation. Thus it is not a common Indian cancer
Important Information
Excess estrogen: 80% of Ca endometrium: Type 1
No association with E excess: 20% of Ca Endometrium: Type 2
Previous year question
Question: A patient of carcinoma breast on tamoxifen is at a high risk of which of the following? (AIIMS 2020)
Ovarian cancer
Endometrial cancer
Myeloid cancer
Contralateral breast cancer
Etiology
Hyperplasias: Cancer
Age group: 45-55 yrs
ENDOMETRIAL HYPERPLASIAS
Simple Hyperplasia without atypia: 1%
Complex Hyperplasia without atypia: 3%
Give Progesterone Therapy
Simple Hyperplasia with atypia: 8%
Complex Hyperplasia with atypia: 29%
Do Simple Hysterectomy
Histopathology
Endometrioid adenocarcinoma
Papillary /villo glandular
Secretory
With Squamous differentiation (mc)15-25%
Mucinous Ca
Serous Ca: Poor prognosis
Clear Cell Ca: poor prognosis
Symptoms
Co-existent obesity, DM, HTN
Irregular acyclical bleeding : Menometrorrhagia
Cyclical bleeding beyond age of menopause
Post menopausal bleeding
Pyometra: Dirty foul smelling vaginal discharge
Diagnosis
1st step: Local examination and Pipelle Endometrial Biopsy
On OPD basis, may use paracervical block
90% sensitive
Fractional curettage [D & C]
Biopsy done from all walls, isthmus
95-99% sensitive
Done in OT
Hysteroscopic biopsy
100% sensitive
Best
Transvaginal sonography:
Not best/ first
Good adjunctive investigation
ET should be ≤ 4mm is normal
5mm or more should be investigated in menopausal women
Important Information
First step in diagnosis of Ca endometrium is not TVS. It is an office endometrial biopsy. Hysteroscopic biopsy is best.
Previous year question
Question: A 50 year old woman presents with abnormal uterine bleeding for 2 years. What shall be the next step in management? (AIIMS 2020)
Hysterectomy
LNG-IUD
Endometrial aspiration and cervical curettage
Progesterone for 3 months
Staging Laparotomy
TAH + BSO: total abdominal hysterectomy + B/L salpingo-oophorectomy
Peritoneal cytology
LN assessment: if involved ? do a biopsy
STAGING OF CA ENDOMETRIUM
2009 FIGO staging system for carcinoma of the endometrium
Stage I: Tumor contained to the corpus uteri
IA: Less than half myometrial invasion
IB: Invasion equal to or more the half of the myometrium
1st line Mx of recurrence → High Progesterone [200-250 mg/day]
Important information
Most common cause of postmenopausal bleeding in India: Ca Cervix
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