Chair and Presenter, Ritu Salani, MD, MBA, and Rachel Frankenthal, MMS, PA-C, MPH, discuss endometrial cancer in this CME/MOC/NCPD/IPCE activity titled “Harmonizing Interprofessional Care With Modern, Molecularly Informed, and Equitable Therapy for Patients With Advanced Endometrial Cancer: Lessons From a Gynecologic Cancer Center of Excellence.” For the full presentation, slides, and complete CME/MOC/NCPD/IPCE information, and to apply for credit, please visit us at PeerView.com/RXV865. CME/MOC/NCPD/IPCE credit will be available until August 29, 2023.

Dr. Lawrence Bandy, one of only 3 gyn oncology specialists in the state, treated a rare form of uterine cancer in Donna Mahen from Searcy, AR. Donna was one of only 50 people to have this form of cancer in the US last year.

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

Studies show it causes a higher risk for African American women

This week, I had the honor of operating on a 59-year-old woman with an unfortunate history of stage 4 cancer arising from her uterus.

She had undergone massive surgery with removal of her uterus, ovaries as well as other organs in her pelvis. She had done quite well for some time but follow-up scans showed a large mass on her left adrenal gland.

Additional scans showed no other evidence of metastasis (meaning spread of the cancer) except to the left adrenal gland. Whenever there is an isolated metastasis to the adrenal gland, surgery is recommended.

She traveled from the Midwest to the Carling Adrenal Center in Tampa to have her surgery. Review her CT scan with me here, showing a large left adrenal mass as well as what the mass looks like after it was removed.

The patient had a Mini Back Scope Adrenalectomy, and even though the tumor was very large (9 cm, Fig 1), the operation took less than 30 minutes.

The patient very much benefited from having surgery through the back as supposed to through the abdomen. Having the Mini Back Scope Adrenalectomy meant that we could avoid all the scar tissue from her previous cancer operation of her uterine cancer.

She flew back home a couple of days later and will continue to be closely followed by her local oncologist.