Endometrial Cancer

Risk factors for endo Ca?? The biggest concern   should be endometrial cancer. She  also has  one risk  factors for   endometrial   cancer including  obesity , , hypertension, but fortunately diabetes, prior   anovulation  ,  late menopause  and nulliparity  are not therte . The  endometrial   sampling  or aspiration  can be  performed   in the office  by placing  a thin  flexible  catheter  through the cervix. It is the initial   test of choice  to  assess for endometrial cancer. This patient   is not taking  unopposed  estrogen   replacement   therapy which     would be another   risk factor. If endometrial  cancer was  diagnosed the patient   would need surgical  staging. If the endometrial sampling is negative for cancer  another   cause for post menopausal   bleeding  such as  atrophic endometrium  is possible.

How accurate is traditional D & C to detect Endo ca?? A blind sampling of the   endometrium  such as with the endometrial biopsy  device,  has 90%  to 95% sensitivity  for detecting cancer. If this patient  who has so many  risk factors for endometrial  cancer, were to have a negative    endometrial   sampling many practitioners would  go to a direct   visualization of the endometrial     cavity   such as hysteroscopy . If the   clinician were to elect  to observe  this patient    after the  endometrial   biopsy  any further   bleeding episodes  would necessitate further  investigation.

ATROPHIC ENDOMETIUM :  The most common  cause of  postmenopausal  bleeding is friable  tissue of the endometrium  or  vagina  due to low  estrogen   levels.

ENDOEMTRIAL  STRIPE:  Transvaginal   sonographic  assessment   of the  endometrial thickness a thickness  greater  than 5 mm  is abnormal  in a postmenopausal woman.

 Clinical approach ?? Priciple:-

 Postmenopausal bleeding always needs to be investigated because it can indicate   malignant   disorders  and premalignant conditions, such  as endometrial hyperplasia. Notably complex hyperplasia with atypia  is associated with endometrial   carcinoma in  30 %  to 50% of cases.

Approximately 20 %   of postmenopausal women  not on hormonal  therapy but complaining  of vaginal   bleeding will have   an endometrial   carcinoma. The    most common  etiology of postmenopausal bleeding    is atrophic endometritis or   vaginitis also    vaginal spotting   can occur   in a patient   taking hormonal   therapy . However   since endometrial malignancy  can coexist with   atrophic  changes or in women taking  hormone replacement     therapy  endometrial   carcinomas  must be ruled out  in any patient  with postmenopausal bleeding.  Possible methods for assessment   of the endometrium include   endometrial sampling hysteroscopy or vaginal  sonography.

They   primarily include conditions  of estrogen   exposure    without  progesterone. Although   endometrial   cancer typically  affects older   women a woman in her 30s with a history   of chronic     anovulation such as  polycystic ovarian  syndrome may be affected. When the endometrial   sampling is unrevealing the patient    with persistent postmenopausal  bleeding or with numerous  risk factors   for endometrial   cancer  should  undergo further evaluation    such as by hysteroscopy. Direct  visualization of uterine cavity  can identify  small lesions  that may be missed  by the office   endometrial sampling device. Additionally  endometrial polyps  can be identified  by hysteroscopy.

Endometrial carcinoma is the most common female  genital  tract  malignancy . Although endometrial cancer   is not the most common  cause of post menopausal bleeding  it is usually the one of  most concern. Fortunately because   endometrial   cancer is associated with an early symptom, postmenopausal bleeding  , it is usually detected at an early stage. Once   diagnosed endometrial   cancer  is staged  surgically . Sometimes endometrial cancer  may occur in the atypical patient such  as a thin patient these cancers tend to be  more aggressive.

DEFINITIONS

ENDOMETRIAL SAMPLING:  A thin catheter  is introduced   through  the cervix  into the uterine  cavity under  some  suction to aspirate endometrial  cells.

ENDOMETRIAL POLYPS :  A growth  of endometrial glands and  stroma , which  projects  into the uterine cavity  usually on a stalk ; it  can cause postmenopausal bleeding.