Discussion with Dr. Gonzalez o Just go through the staging to get an idea of the
prognostic factors:
50 year old G0P0 complains of intermittent heavy • Prognostic Factors
vaginal bleeding for the past 6 months. She started to have o Makes outcome worst:
irregular menses at age 48. PMH: Stage 2 Breast Cancer, right Histologic type
s/p MRM & 6 cycles of chemotherapy; on Tamoxifen since • Endometroid adenoCA usually
January 2012. FH: (+) Breast CA, mother; (+) Colon CA, 2 • Worse types: clear cell and
sisters; PPE: BP: 150/90, PR – 90/min; RR- 22/min, T – 36.8 seropapillary? sites
C, BMI – 28; Pale palpebral conjunctiva; Breast: L – no mass. Grade – do not confuse it with staging
Abdomen – flabby, soft, no mass nor tenderness, speculum: Depth of invasion to the myometrium
cervix – pink, moderate bleeding from os; IE: cervix – firm, Lymph node
short, closed; uterus – anteverted, 2 months size, mobile; Lymphovascular space invasion
adnexa – no mass nor tenderness. • If there is tumor cells within the
capillaries, there is already a process of
Questions: metastasis and this needs to be
• Risk factor of the patient to developing the disease: considered in adjuvant treatment
o Past Medical History of Cancer Breast cancer ER and PR positive estrogen response
Tamoxifen you may use anti estrogen
o Family History • Grade 1 –usually positive
o Nulligravidity • Grade 3 usually negative
She is subjected to the cyclic effects of her o The prognostic factors after explored, would
hormones (mainly estrogen) determine the treatment
The multigravida will have a time where the • OBSERVE if: Stage I-A G1 or G2. More than this,
pregnancies would allow her to have a rest wala na. Chemo or radiation should be ensued.
from the estrogen predominance will have a
rest.
o Age of the patient
Epidemiologic data shows that endometrial
cancer is high also in older age.
The older the woman is, the more peripheral
conversion there is.
o BMI
Obese women have more estrogen
stroma of adipose tissue is where
androstenedione is converted to estrone.
Concept: peripheral conversion
o Hypertension
Co morbid disease
• In other patients, what else would have high estrogen
o Thecoma
o Germ Cell Tumors
o Hormone Replacement Therapy (Estrogen
Replacement Therapy)
o OCPs not so much
Originally: High levels of estrogen and
regular level of progesterone caused
hyperplasia and cancer in the users.
Reformulated OCPs: estrogen was low dose
and regular progesterone levels
Thus, now, it does not present with the
problems anymore.
Discussion
• Do a speculum exam
o Rule out vaginal lesions
o Rule out gross cervical lesions
o If there is bleeding from the os, suspect the
possibility of bleeding from the higher up (uterus).
• Basic work-ups:
o Transvaginal examination
Expect a tumor in the endometrium
Check for the endometrial thickness. Should
not go beyond 5 mm. thicker than that, it is
abnormal.
If thick, do an endometrial biopsy
o CBC
o Platelet count
o Blood typing
o Work her up for comorbidities
Screen for diabetes
• Once Endometrial cancer is confirmed:
o Do a chest x-ray first before
o Kidney function
o Liver function test
• Primary treatment:
o SURGERY
TAHBSO
• BSO since it is a potential source of
estrogen and site of metastasis “Success is sweeter when you work hard for it and not cheat for it. It’s better to
Peritoneal fluid cytology be mediocre with a clean conscience than to be on top with a callous
• Check for ascetic fluid and get a sample. conscience.”
• Lavage 200 cc and then drain and send
for cytology These are just notes taken down by a nocturnal medical student at 7 AM in the
Lymph Nodes (take out) morning. Study at your own risk.
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