This patient presents with postmenopausal vaginal bleeding and endometrial biopsy consistent with Stage I endometrial carcinoma. The appropriate treatment for unstaged endometrial carcinoma is total abdominal hysterectomy and bilateral salpingo-oopherectomy (TAHBSO).
Risk factors for endometrial carcinoma include nulliparity, late menopause, diabetes, obesity, unopposed estrogen therapy, and tamoxifen use. Treatment of all primary diagnoses of endometrial carcinoma includes TAHBSO and surgical staging. High risk cancers are treated with additional radiation and pelvic and para-aortic lymph node sampling based on stage.
Buchanon et al. review endometrial carcinoma. Tools that aid in diagnosis and detection include endometrial biopsy, ultrasonography, saline infusion sonography, and hysteroscopy. Definitive diagnosis always requires histologic confirmation through endometrial biopsy or dilatation and curettage.
Armstrong et al. discuss endometrial hyperplasia (EH), a precursor to endometrial carcinoma. After menopause, EH is more common in women with increased levels of circulating estrogen often due to obesity or estrogen replacement therapy. There is some risk of coexisting cancer in women with a diagnosis of EH at endometrial sampling.
Illustration A shows an endometrial adenocarcinoma invading uterine muscle. Illustration B shows a well-differentiated endometrioid adenocarcinoma composed of numerous, small, crowded glands with varying degrees of nuclear atypia, mitotic activity, and stratification.
Answer 1: Total abdominal hysterectomy is not appropriate treatment for endometrial carcinoma as it neglects the ovaries and fallopian tubes.
Answer 2: Radiation alone is not appropriate primary treatment for endometrial carcinoma.
Answer 4: High-dose progestin therapy is a first-line treatment for recurrent disease.
Answer 5: Fractional dilation and curettage can be used to sample the endometrium during diagnosis but is not appropriate treatment for endometrial carcinoma.
Buchanan EM, Weinstein LC, Hillson C. Endometrial cancer. Am Fam Physician. 2009 Nov 15;80(10):1075-80
PMID:19904892 (Link to Abstract)
Armstrong AJ, Hurd WW, Elguero S, Barker NM, Zanotti KM. Diagnosis and management of endometrial hyperplasia. J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):562-71. doi: 10.1016/j.jmig.2012.05.009. Epub 2012 Aug 3. Review
PMID:022863972 (Link to Abstract)