Endometrial Cancer : Obstetrics and gynaecology Video lectures Version 2.0 ( Medvizz app )

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Endometrial Cancer : Obstetrics and gynaecology Video lectures Version 2.0 ( Medvizz app )

Endometrial cancer is an adenocarcinoma of uterine tissue that is commonly related to exposure to high levels of estrogen. It is the most common of the gynecologic cancers. (Note: According to the CDC, the 4 gynecologic cancers are: endometrial, ovarian, cervical, and vulvar. Breast cancer is NOT classified as a gynecologic cancer.)

According to the endometrial intraepithelial neoplasia schema, which has largely replaced the simple/complex hyperplasia with/without atypia classification, the following three diagnostic categories are:
• Benign endometrial hyperplasia (benign)
• Endometrial intraepithelial neoplasia (precancerous)
• Endometrial adenocarcinoma, endometrioid type, well differentiated(malignant)

Risk factors include:
• Prolonged unopposed estrogen exposure
• HNPCC (hereditary nonpolyposis colorectal cancer)
• Diabetes and obesity
• Hypertension
• Polycystic ovarian syndrome and chronic anovulation
• Nulliparity
The average age of diagnosis is 61, but the age range of 50-59 is the largest affected group.
Endometrial cancer manifests clinically with postmenopausal vaginal bleeding. Note that the most common cause of vaginal bleeding in postmenopausal women is atrophic vaginitis, but endometrial cancer must be ruled out.
In addition to postmenopausal vaginal bleeding, symptoms associated with endometrial cancer include:
• Heavy menses
• Mid-cycle bleeding
• Abdominal pain
• Fixed ovaries or uterus if tumor has extended locally
Endometrial biopsy is the gold standard for diagnosis of endometrial cancer. Findings associated with endometrial cancer include hyperplastic, abnormal glands with vascular invasion.
Serum studies may show an elevation of the CA-125 tumor marker. Remember that tumor markers are not diagnostic, but are useful for monitoring response to therapy.
In a patient where the suspicion for endometrial cancer is very high but the endometrial biopsy is normal, hysteroscopy with biopsy should be performed to visualize the uterine cavity and take additional samples.
A chest X-ray and CT can be used to detect the presence of metastases and ultrasound can be used to detect cervical masses and measure endometrial wall thickness.

Complications of endometrial cancer include:
• Local extension to fallopian tubes, ovaries, and cervix
• Metastases to the peritoneum, pelvic lymph nodes, aortic lymph nodes, lungs, and vagina
• 96% 5-year survival rate if local, but 25% 5-year survival rate if metastases are present
Regardless of stage, endometrial cancer can be treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO).
According to NCCN guidelines, if fertility is desired, patients with grade I endometrial cancer limited to the endometrial lining (stage IA) can be treated with the following:
• continuous progestins AND
• D&C or endometrial biopsy every 3-6months AND
• TAH-BSO once childbearing is complete
If an endometrial tumor cannot be completely surgically resected, it should be debulked.
In addition to surgery, adjuvant radiation therapy is indicated if the endometrial cancer is high-grade or the tumor has invaded beyond the endometrial lining.

Chemotherapy is indicated for use in any case where endometrial cancer has spread beyond the uterus.
Patients who cannot be cured by surgery and radiation may show benefit from the use of hormone therapy using progesterone.
3-5% of endometrial cancers are due to Lynch syndrome. Remember from Step 1 that Lynch syndrome is associated with defects in mismatch repair genes, and patients have a 40-60% lifetime risk of endometrial and colon cancer. According to the Society for Gynecologic Oncology (SGO), all patients with endometrial cancer should be screened for Lynch syndrome through either a systematic family history or universal tissue genetics from all endometrial cancers.

A family history suggestive of Lynch syndrome includes:
• Colorectal carcinoma (CRC) diagnosed at age greater than 50
• Synchronous or metachronous CRC or other Lynch syndrome-associated tumors, regardless of age;
• CRC with high microsatellite instability on tumor immunohistochemistry in a patient less than 60 years old;
• CRC diagnosed in a patient with two or more first-degree or second-degree relatives with Lynch syndrome-associated tumors, regardless of age
• CRC diagnosed in a patient with at least one first-degree relative with an HNPCC-related tumor before the age of 50

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• Category

  Uterine Cancer