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Case 17 • Biopsy.

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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