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Table 9. Staging of Endometrial Cancer (Surgical Staging)

Stage

Description

0

atypical adenomatous hyperplasia

1 1A 1B 1C

confined to corpus tumor limited to the endometrium invades through < one half of myometrium invades through > one half of myometrium

2 2A 2B

involves corpus and cervix endocervical glandular involvement only cervical stromal invasion

3 4

outside of uterus but not beyond true pelvis outside of true pelvis, involving bowel and bladder

GYNECOLOGICAL ONCOLOGY . . . CONT.

types adenocarcinoma

• adenosquamous carcinoma • papillary serous adenocarcinoma risk factors • nulliparity • unopposed estrogens • endogenous - PCOD, anovulation, obesity • exogenous - estrogen in HRT without progesterone (and presence of a uterus) • late menopause • history of breast, colon, or ovarian cancer • diabetes mellitus, hypertension are cofactors clinical presentation • postmenopausal bleeding • 70-80% present at Stage 1 • 10-15% present at Stage 2 • abnormal uterine bleeding

d i a g n o s i s o f f i c e e n d o m e t r i a l b i o p s y D & C treatment b a s e d o n t u m o u r g r a d e a n d d e p t h o f m y o m e t r i a l i n v a s i o n s u r g i c a l T A H - B S O a n d p e l v i c w a s h i n g s r a d i o t h e r a p y a d j u v a n t r a d i a t i o n i s g i v e n t o s e l e c t e d p a t i e n t s b a s e d o n d e p t h o f m y o m e t r i a l i n v a s i o n , t u m o u r g r a d e , a n d / o r l y m p h n o d e i n v o l v e m e n t h o r m o n a l t h e r a p y p r o g e s t i n s f o r d i s t a n t o r r e c u r r e n t d i s e a s e c h e m o t h e r a p y m a y b e t r i e d i f d i s e a s e p r o g r e s s e s o n p r o g e s t i n s

Notes

Uterine Sarcoma rare a r i s e f r o m s t r o m a l c o m p o n e n t s e n d o m e t r i a l s t r o m a , m e s e n c h y m a l o r m y o m e t r i a l t i s s u e s m o r e a d v a n c e d a t d i a g n o s i s g r e a t e r t e n d e n c y t o d i s s e m i n a t e h e m a t o g e n o u s l y 5 - y e a r s u r v i v a l : 3 5 % l e i o m y o s a r c o m a • uncommon a v e r a g e a g e o f p r e s e n t a t i o n = 5 5 c l i n i c a l p r e s e n t a t i o n a b n o r m a l v a g i n a l b l e e d i n g f e e l i n g o f p e l v i c f u l l n e s s a n d / o r p r e s s u r e r a p i d l y e n l a r g i n g u t e r u s s p r e a d v i a l o c a l i n v a s i o n , h e m a t o g e n o u s a n d l y m p h a t i c

Gynecology 44

MCCQE 2000 Review Notes and Lecture Series

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