Describe the indication and procedure of surgical management.
Indication: women with endometrial cancer who are postmenopausal, perimenopausal, or do not intend to become pregnant
Procedures
Total hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) with or without lymph node removal
Advanced radical hysterectomy and removal of the upper vagina according to Wertheim-Meigs additional
Describe the nonsurgical management.
Progestins: Indicated for women with early stage endometrial carcinoma (well-differentiated and progesterone and estrogen receptor positive) , who would prefer to avoid TAH-BSO and preserve fertility, or as adjuvant therapy
Radiotherapy and/or chemotherapy (adjuvant or palliative)
Describe a complication of endometrial cancer.
An accumulation of pus in the uterine cavity
Caused by infection resulting from obstruction of the cervical opening by the tumor and secondary blood stasis (hematometra)
Can develop in patients with duplication of the cervix or as an uncommon complication of gynecological malignancy
Presented with purulent vaginal discharge, lower abdominal pain, and enlarged uterus
Diagnosed by imaging studies (e.g., abdominal ultrasound or CT scan)
Treated with drainage and dilation of the cervical lumen
Describe the prognosis.
Endometrial cancer has the 2nd best prognosis (after cervical cancer) of all gynecological cancers in the US.
Cancer stage at diagnosis determines the 5-year survival rate:
Localized endometrial carcinoma: > 90 %
Metastasized endometrial cancer: 16.8 %
Death rate: 4.9 per 100,000 women per year
Types of endometrial carcinomas that are well-differentiated and possess estrogen receptors (type I) have a more favorable prognosis.
Clear cell and papillary serous carcinomas (type II) have an aggressive course and a poor prognosis.
To remember the prognoses of gynecological cancers, think of “CEOs (Cervical, Endometrial, Ovarian cancers) progressively decline.
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