APGO Educational Objectives: 

Endometrial carcinoma is a major concern for women using estrogen replacement therapy. As with other neoplasms, early diagnosis will improve long term survival.

The student will demonstrate a knowledge of the:

  1. approach to the patient with postmenopausal bleeding
  2. risk factors for endometrial carcinoma
  3. symptoms and physical finding
  4. methods to diagnose and stage endometrial carcinoma
  5. course of the disease



 

 

 

 

 

 

Recommended Reading Assignment:

  1. Endometrial Carcinoma, Chapter 46 in Obstetrics and Gynecology, 3rd Edition, Beckmann, et al, pp. 539-549, 1998

 

 

 

 

 

 

 

 

 

Questions:

  1. What are the risk factors for the development of endometrial adenocarcinoma? Also, discuss patients in whom a diagnosis of endometrial cancer should be excluded. List three other causes of postmenopausal bleeding that are not malignancies.
  2. What work up should be undertaken in this patient at the present time and are there any office procedures which would lead to a diagnosis?
  3. What preoperative investigations should be performed?

The patient underwent a biopsy which revealed a Grade 2 endometrial adenocarcinoma. The chest x-ray, IVP and barium enema were all within normal limits.

  1. What surgical procedure needs to be performed?
  2. Review and be prepared to discuss the current surgical staging system for endometrial adenocarcinoma.

The patient had peritoneal washings obtained which were without evidence of malignant cells, but she had a 4 cm. tumor in the fundus of the uterus with 60% myometrial invasion and one left external iliac lymph node positive for metastatic disease.

  1. What is her FIGO stage? What postoperative adjuvant therapy would be recommended?
  2. What are five other prognostic variable which may assist in your decision to offer adjuvant therapy to this patient?
  3. What follow-up treatment will you offer to this patient and what is her prognosis?