Endometrial Cancer Past Paper PDF

## Indications to ICSI - Sever deficiency in semen quality - Azoospermia ### Abbreviations: - TSA - testicular sperm aspiration - TSE - testicular sperm extraction - PSA - Percutaneous Sperm aspiration - HESA - Hiero epidermis Sperm aspiration ## Endometrial Cancer (EC) - It is a post menopausal c...

## Indications to ICSI - Sever deficiency in semen quality - Azoospermia ### Abbreviations: - TSA - testicular sperm aspiration - TSE - testicular sperm extraction - PSA - Percutaneous Sperm aspiration - HESA - Hiero epidermis Sperm aspiration ## Endometrial Cancer (EC) - It is a post menopausal cancer. - It is the 4th most common cancer in females. - For women aged 70-74: - Incidence of stage 1 is 85.6-90% - Incidence of stage 4 is 15% ### Incidence from ten teachers: - 95 per 100,000 women - Lifetime risk to develop EC is 4.6% - Mean age of diagnosis is 62 years - 25% occur before menopause - The incidence increases over the past 20 years as a consequence of an aging population. ## Risk Factors: - Source: MSD Pro. - Unopposed estrogen: high serum estrogen and no progesterone. - Age +45 years old. - Obesity. - Tamoxifen use for over 7.2 years. - Lynch Syndrome. - Previous pelvic radiation therapy. ## Other Risks - Exposure to extrinsic or intrinsic estrogen. - CD obesity. - Androgen deficiency (AT). - PGs or other ovulatory dysfunction. - Estrogen therapy without progesterone. - Nulliparity - Early menarche - Late menopause - Sporadic mutations making tumor. ## Endometrial CA - Can be caused by sporadic mutations. - About 5% of patients have inherited mutations that cause the cancer. - Endometrial CA due to mutations occur early and are often diagnosed 10-20 years old. ## Lynch Syndrome - CHN PCC (hereditary non-polyposis colorectal syndrome) - Patients with Lynch syndrome have a high risk to develop other cancers like colorectal, ovarian and breast cancers. ## Clinical features: - Source: Dr. Mohammed Salah lecture ## Symptoms: - 96% PMB and post menopausal bleeding = EC - Pre-HP, Inter-MP, persistent heavy MP ## Examination: - By speculum: see vulva, vagina (atrophic vaginitis). - By manual examination: feel a mass. ## Investigation: - TVUS (transvaginal US), usually performed when patients present with heavy bleeding for 2 days because it has several advantages: - Inexpensive - Non-invasive - Able to see endometrial thickness - If thickness is less than 4 mm, it is normal and no further investigation is needed. - If thickness is 5 mm, it is regular, and the patient should have a biopsy. - If thickness is irregular, hysteroscopy and D&C (direct visualization and therapeutic) are done with a risk of infection. - If a patient is 74 years old and doesn't have atypia, there is no risk of cancer and only medical treatment is given. - If there's atypia, there is a risk of cancer and medical treatment and hysteroscopy are given. - If a sample is needed, an endometrial biopsy is taken by fine tube catheter, which is easy, fast, and accurate 100%. - The failure rate is high in the case of inadequate samples. - It is painful. - So, doctors should give the patient a non-estrodial anti-drug before the biopsy. - There is a risk of bleeding and perforation. - Intra-patient investigation has an increased risk of anesthesia and bleeding. - Other investigations: CBC, RFT, CT, MRI, PET scan ## Stages: - **Stage 1:** in uterus - 1A < 55% - 1B > 55% - **Stage 2:** reach cervix - **Stage 3:** reach LN - 3A: serosa - 3B: vagina - 4: 4A: bladder, rectum - 4B: distant metastasis ## Management - **Stage 1:** Surgery with Laparoscopy or open surgery = 90% survival rate. - **Stage 2:** Modified radical hysterectomy: remove the vagina, paracervical and para-metrial tissue to ensure adequate excision margins. - **Standard surgery:** for stage 1: total hysterectomy and removal of both fallopian tubes and ovaries (bilateral salpingo-ophorectomy BSO). - **Stage 3:** De-bulking and take off every metastasis, if possible. - Chemoradiation therapy is used. - **Stage 4:** Palliation ***Source: "Ten Teachers"***