QUESTION & ANSWERS TREATMENT ENDOMETRIAL CANCER | aqorn learning | @rahat2021| FCPS | MCPS | TOACS |

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When assessing abnormal vaginal bleeding, it's essential to determine its source, which could be the cervix, vulva, or vagina. A visual examination can often identify lesions in these areas. If a pap smear indicates an abnormality, further evaluation is necessary, even if no obvious abnormalities are seen.
Vaginal dryness due to atrophic changes may result in postcoital bleeding. Uterine bleeding may be caused by various benign conditions like polyps, endometritis, or hormone replacement therapy.
Imaging Studies: Vaginal ultrasonography is the initial diagnostic step due to its minimal invasiveness. Hydro ultrasonography involves introducing a small amount of saline into the endometrial cavity and then repeating the vaginal ultrasound, reducing the risk of false positives compared to traditional vaginal ultrasound.
Procedures: Endometrial biopsy, typically performed in an office setting, is a quick and well-tolerated method for diagnosis. If symptoms persist, further evaluation of the endometrial cavity may be needed.
Hysteroscopically directed biopsy provides a precise view of the endometrium and enables targeted biopsies.
Dilatation and curettage are seldom used because most diagnoses can be made in the office.
Anesthesia-assisted examination becomes necessary when a patient with stenotic cervical os experiences bleeding, making adequate endometrial sampling challenging.
Histologic Findings
Histologic examination of the endometrial cavity is the gold standard for diagnosis.
Approach Considerations
The standard approach to endometrial cancer involves surgery followed by chemotherapy and/or radiation therapy, especially in cases of recurrent disease. Surgery's success is influenced by factors like the absence of residual disease after resection and histotype.
Surgery is typically combined with chemotherapy using a taxane and a platinum compound like paclitaxel plus carboplatin.
Since 1988, FIGO guidelines recommend surgical staging for endometrial cancer as it provides more accurate information than clinical evaluation. Presurgical evaluation includes special studies like CT scans or MRIs, anesthesia assessment, and a comprehensive surgical procedure including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology, and lymphadenectomy. Staging depends on surgical findings, guiding subsequent therapy. Laparoscopy can be an effective alternative.
Pharmacologic Therapy
Endometrial cancer treatment is tailored to individual patient factors and disease stage. Surgery remains the primary treatment, but radiation therapy, chemotherapy, and hormonal therapy can be used as adjuvant therapy, for recurrences, metastatic disease, or when surgery is not feasible.
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Hi, This TH-cam channel has been created to help postgraduate trainees in Obstetrics and Gynecology learn and develop clinical skills for history taking, communication, counselling, quality assurance, critical reading of the literature.

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