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ENDOMETRIAL CANCER

It is the most common gynecological malignancy

        It is associated with

a.      Diabetes

b.      Hypertension

c.      Obesity

d.      Use of exogenous estrogens

 

        Most cases are adenocarcinomas

        It is usually found in post-menopausal women, although about one fifth of patients are pre-menopausal.

 

Signs and Symptoms:

        Post-menopausal bleeding

        Lower abdominal and supra-pubic fullness in advanced cases

        Urinary symptoms

        Constipation

        Weigh loss in advanced cases

        Vaginal discharge

        Anemia

        Pelvic fullness/pain

        Leg swelling

 

Prognostic Factors are:

        Extent of the tumor at diagnosis

        Degree of differentiation

        Performance status

        Tumor size

 

Management:

        Fractional dilatation and curettage required for tissue diagnosis

        Pap smear is not reliable for diagnosis

        Total abdominal hysterectomy, surgical staging with pelvic and para-aortic lymphadenectomy may be performed to know who would benefit from radiation therapy

 

Adjuvant Treatments:  include the use of the following:

        Aderamycin plus Cisplatin

        Paclitaxel

        Hormonal therapy may be used in recurrent metastatic diagnosis, e.g., megre, Tamoxifen and Medmoxy Progesterone.  It is of no benefit in the adjuvant setting

        In patients with uterine sarcomas, the treatment is by performing total abdominal hysterectomy and removal of both fallopian tubes and ovaries.  Chemotherapy is of no benefit and radiation to the pelvis after the surgical resection only reduces local recurrence of the tumor.

        In recurrent metastatic disease, the following agents are in use:

a.      Doxorubicin

b.      Ifosfamide

c.      Cisplatin