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Case History

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Image not available. A 34-year-old nulliparous woman presents with six months' history of irregular menstrual bleeding. She has a body mass index of 35 kg/m2 and was diagnosed with polycystic ovary syndrome (PCOS) a few years ago. A pipelle biopsy is taken which shows a grade I endometrioid adenocarcinoma.

What is the standard treatment for endometrial cancer?

What is the role of laparoscopy in endometrial cancer?

Can fertility be preserved in endometrial cancer?

What is the optimal type of adjuvant radiotherapy and the role of chemotherapy in endometrial cancer?

Can hormone replacement therapy be given after endometrial cancer?

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Background

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What is the standard treatment for endometrial cancer?

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Image not available. Endometrial cancer is the most common gynaecological cancer in the industrialized world. Standard treatment for early endometrial cancer (International Federation of Gynaecology and Obstetrics [FIGO] stage I; Table 46.1) is surgery consisting of a total abdominal hysterectomy and bilateral salpingo-oophorectomy (Figure 46.1). Peritoneal washings should also be collected and the peritoneal surfaces carefully examined for the presence of tumour implants. Furthermore, pelvic lymph node dissection is advocated by many for diagnostic, therapeutic and prognostic purposes. It facilitates targeted therapy to maximize survival and to minimize the effects of undertreatment and potential morbidity associated with overtreatment (e.g. radiation toxicity). The use of lymphadenectomy – selective node sampling versus formal lymphadenectomy, and pelvic versus pelvic plus para-aortic lymphadenectomy – remains controversial. The American College of Obstetricians and Gynecologists (ACOG) advocates full pelvic and para-aortic lymph node dissection.1 The incidence and severity of complications associated with extensive surgical staging is low and is most frequently related to the effects of existing medical comorbidities (i.e. obesity, diabetes). The average hospital stay for full staging is similar to that for standard hysterectomy.

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Table 46.1FIGO staging for endometrial carcinoma
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Figure 46.1

Algorithm for management of early stage endometrial cancer. LVSI = lymphovascular space involvement; TAHBSO = total abdominal hysterectomy and bilateral salpingo-oophorectomy.

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What is the role of laparoscopy in endometrial cancer?

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There has been a recent trend towards laparoscopic management of ...

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