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1. Direct spread:
EC usually spreads first on the surface of the
endometrium, called surface rider tumour filling the whole
uterine cavity. It may then invade the muscular layer of the
uterus, the myometrium, by direct spread
2. Lymphatic spread:
EC also spreads through lymphatic channels draining the
fundus, the cornu and the isthmus to the para-aortic, inguinal
and paracervical lymph nodes respectively.
3. Vascular spread:
Such metastases may invade the ovaries, the adnexa or
the vagina as near by organs with poor prognosis, or may be
carried to distant organs as the liver, lungs, brain and bones
where the disease reaches a terminal stage
GRADING AND STAGING
correlates with:
Both the stage and grade of the tumour.
Depth of myometrial invasion.
Lymph node involvement.
Endometrial carcinomas generally has a
good prognosis with > 85% 5 year survival
when diagnosed in stage I.
Grade III tumours have a poorer prognosis
stage by stage compared to grade I and II.
The presence of tumour cells in the
peritoneal cavity detected by cytology from
peritoneal wash will upstage the tumour from
stage I to stage III.
CLINICAL PRESENTATION
Post-menopausal bleeding is the chief clinical
presentation in early cases of endometrial carcinoma
to the extent that any bleeding in elderly women
should be promptly investigated to exclude
malignancy.
Irregular uterine bleeding will be the main
complaint in patients who still have their cycles.
Bleeding is usually profuse, persistent and recurrent
even after attempts using medical treatment.
Other symptoms include vaginal discharge, lower
abdominal pain & menstrual like cramps
DIAGNOSIS
Fractional Curettage (endocervical and endometrial
curettage), under aneasthesia, is the gold standard
in the diagnosis of endometrial carcinoma.
Diagnosis on outpatient setting is established via
TVS for determination of endomtrial thickness, and
outpatient endometrial sampling using
instruments as the pipette sampler, or Novak curette,
in cases with abnormal endometrial thickness in the
menopause (>6.0 mm)
Outpatient hysteroscopy
abdominal examination, PV & PR, bimanual
pelvic vaginal examination
Cytology is not very reliable, in contrast to
cancer cervix, with < 50% accuracy in the
diagnosis.
Cystoscopy, CT scan and MRI may have a role in
determining the spread of the disease within the
myometrium and outside the uterine corpus
Curettage
Hysteroscopy
TREATMENT OF ENDOMETRIAL
CARCINOMA