Endometrial Cancer

Endometrial cancer is the cancer of the lining of the uterus and is the most common malignancy of female genital tract in western world.

Fourth most common cancer after breast, lung, colorectal cancer
Mostly caused by sporadic mutations
Genetic mutations – 5 % patients (occur 10-20 years earlier)

Risk Factors :

• Obesity
• Early menarche,late menopause
• Unopposed estrogen exposure
• PCOD
• Estogen secreting tumors
• Tamoxifen therapy
• HPNCC
• Nulliparity
• Diabetes mellitus
• Hypertension
• Previous RT

Symptoms

• Abnormal vaginal bleeding-90% patients
• Postmenopausal bleeding
• Intermenstrual bleeding
• Heavy and prolonged periods
• Purulent vaginal discharge

Causes Of Post-Menopausal Bleeding

Diagnosis

• Office endometrial biopsy with endocervical currettage (false negative rate – 10%)
• Hysteroscopy and directed biopsy

Surgical Management

• Hysterectomy with BSO And surgical staging
• Sentinel lymph node to be done in uterine confined low and intermediate risk histology.
• Visual inspection of peritoneal, diaphragmatic and serosal surfaces with biopsy of any suspicious lesions
• Peritoneal cytology should be collected and reported (does not affect staging)
• Omental biopsy (deeply invasive, high grade endometroid adenoca and carsinosarcoma).If grossly normal( 5x5 cm) biopsy taken
• If high risk histology, then complete pelvic and retroperitoneal lymph node dissection
• Excision of suspicious and enlarged lymph nodes in pelvic and retroperitoneal region

Minimally invasive surgery

• A randomized, phase III trial conducted by the Gynecologic Oncology Group (LAP2) compared laparoscopy versus laparotomy stage I to IIA uterine cancers 
• results > morbidity is lower MIS and survival and recurrence rates do not differ greatly.
• Robotic surgery is FDA approved for ca endometrium

Adjuvant therapy

May be required in select cases depending upon the final histopathological evaluation.