Hormonal therapy has also been found to be an option for some young women with endometrial Cancer who wish to prevent infertility….

Emobileclinic Patient’s corner

Emobileclinic Specialist

Endometrial carcinoma is a relatively rare tumour in Nigeria compared with carcinoma of the cervix. It is seen more frequently in the developed countries where is the commonest malignancy in America. In Nigeria it represents just about 0.88% of the female cancer and 2.43% of female genital cancer. The disparity could be attributed to under diagnosis due to lack of diagnosis facilities, limited use of oestrogen therapy for postmenopausal women, higher parity and smaller ratio of women surviving to old age. It is common to postmenopausal (75%) with peak age incidence of 60-70 years and before menopause in 25% of patients. 

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The main predisposing factor to development of endometrial carcinoma is chronic unopposed exposure of oestrogen which could be endogenous or exogenous. Endogenous factors include obesity and chronic anovulation while exogenous factor is seen in administration of unopposed oestrogen especially for hormone replacement therapy. The last scenerio presented with postmenopausal bleeding which is the commonest mode of presentation. For women who are still menstruating, they may present with intermenstrual bleeding which may prolonged or heavy and they occasionally present with watery or purulent vaginal discharge. The diagnosis of our patient was confirmed by histology of endometrial sample obtained by Fractional Curettge and this method has a predictive method value 87-97%.Vacuum currettage is an alternative with predictive value that is near that of Fractional currettage. It has the advantage of no anesthesia therefore reducing cost and potential complications. Other techniques include endometrial brush, gravlee set washer and vibra aspirator. In addition to confirming disease and the histological type of endometrial cancer . Staging of endometrial cancer is radiological using a magnetic resonance imaging. 

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The main stream treatment is laparotomy with total abdominal hysterotomy and bi-lateral salpingo-oorectomy for stage 1 disease. Wertheim’s radical hysterotomy with pelvic  lymphadenectomy is the treatment of choice where MRI suggests cervical involvement in addition to adjuvant radiotherapy by either brancy therapy or teletherapy. 

Hormonal therapy has also been found to be an option for some young women with endometrial Cancer who wish to prevent infertility, but the  putative benefits of adjuvant hormone therapy with high dose gestagen has not yet been conclusively demonstrated. 

Recent randomized and control trial have cast doubt on two mainstray of the primary treatment of endometrial cancer :surgical lymphadenectomy and adjuvant external radio therapy. The controversy surrounding  pelvic and para aortic lymphadenectomy in the surgical treatment of endometrial cancer as discussed in a large Scale, retrospective multi variate analysis of date in the SEER database (Surveillance , Epidemiology and End results ; National Cancer Institute, USA) and has led to the conclusion that lymphadenectomy prolong survival to a statistically significant extent both in the advanced stage of endometrial carcinoma- (5 years survival :stage II, 74% Vs 63% sptage IV, 53% Vs 27%) and in poorly differentiated stage 1 carcinoma (grade 3) (5 years survival :90% Vs 85%). 

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In view of the toxicity of external teletheraphy, vaginal beachytherapy seem to be a reasonable compromise and women who had received only vaginal brancytherapy were found to have significant few adverse effects and therefore had a better quality of life. The benefits of adjuvant chemo or combined radio and chemo therapy in stage I and II has yet to be demonstrated in a clinical trials. Essentially for cancer with high risk of recurrence (e. g grade 3 serious and clear cell histology), the current form of treatment still yield highly unsatisfactory survival rate. 

The significant prognostic factors include dept of invasions, histology type, vascular space involvement, positive peritoneal cytology results and medical disorders that contribute to the mortality rate. Endometrial carcinoma is a slowing growing tumour and is usually confined for a considerable length of time. Five years survival rate for 1a disease is 60-93%



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