Endometrial Carcinoma

Aetiology:

Endometrial carcinoma occurs in postmenopausal women and women who have had prolonged exposure to estrogen stimulation, i.e nulliparous women, late menopause, obese women and women with polycystic ovaries. Hyperplasia is a precursor.

Clinical Features:

Postmenopausal bleeding is the classic presentation for endometrial carcinoma and therefore requires investigation. It is rare in women under the age of 40, unless there are predisposing factors, e.g.PCO. Abdominal and pelvic examinations should be carried out in all cases. A cervical smear should be taken and endometrial sampling considered. Endometrial sampling can be performed in the outpatient clinic. Transvaginal ultrasound scanning may be helpful in identifying changes(5mm endometrial thickening is suspicious). Instilling fluid into the endometrial cavity at the time of transvaginal scanning may improve diagnostic accuracy. If out-patient sampling is not possible then hysteroscopic assessment becomes necessary.

Investigations:

A Total Abdominal Hysterectomy and Bilateral salpingo-oophorectomy is performed during a staging operation which involves taking peritoneal washings and sampling enlarged pelvic and para- aortic nodes. Adjuvant radiotherapy is sometimes necessary to complete treatment for high-grade lesions and cancers that involve the outer half of the endometrium.

Management:

Factors influencing survival endometrial carcinoma are age at diagnosis, stage of disease, pathological type and degree of differentiation of the lesion and the depth of myometrial invasion.