Title OVARIAN & ENDOMETRIAL TUMOUR ✅

LONG CASE ENDOMETRIAL CANCER CASE 1 EXAMINER NO GILIRAN PELAJAR BATCH FINAL DIAGNOSIS PROBLEM LIST PROF ANISAH PROF HASIB USM S22 BATCH 6 ENDOMETRIAL CANCER 1. Important social history 2. Pdx 3. Differential diagnosis 4. Investigation CASE 1 No case written. NO SPECIFIC QUESTIONS FOR THE CASE OR OTHER PROBLEM LIST SOURCE 1. Important Social History ● History of smoking - increased in risk in type 2 endometrial carcinoma, but decreased risk of type 1 endometrial carcinoma ● Alcohol consumption ● Recreational drug use Geeky medics, Endometrial carcinoma history taking https://geekymedics.c om/endometrial-cance r/ 2. Provisional diagnosis Endometrial carcinoma- Diagnosis based on history, physical examination, transvaginal ultrasound and endometrial sampling 1. History Symptoms ● Post menopausal bleeding ● Irregular and heavy bleeding Gynaecology Ten Teachers, 20th edition, pages 206-207
● Intermenstrual bleeding Later symptoms in advanced disease ● Pelvic pain ● Abdominal distension ● Feeling of fullness in the abdomen ● Unexplained weight loss ● Abnormal bowel or bladder function 2. Risk Factor Factors that increase risk endometrial cancer type 1 ● Obesity ● Diabetes ● Nulliparity ● Late menopause ● >52 years ● Unopposed estrogen therapy ● Tamoxifen therapy ● Family history of colorectal and endometrial cancer Factors that protect against endometrial cancer type 1 ● Hysterectomy ● Combined oral contraceptive pill ● Progestin-based contraceptives, including iniectables ● Intrauterine device, including Cu-IUD and LNG-IUS ● Pregnancy ● Smoking 3. Physical examination ● Bimanual pelvic examination: Bulky uterus ● Speculum examination: Bleeding from the cervical os ● Pelvic mass may be palpated - in advanced presentations
3. Differential diagnosis ● Endometrial polyps -As with endometrial carcinoma, may present with abnormal uterine bleeding -Differentiated by transvaginal US showing non uniform thickening of the endometrium or focal mass ● Endometrial hyperplasia -As with endometrial carcinoma, may present with AUB and endometrial thickening on US -Similar predisposing factors, age group affected -Differentiated using histopathologic findings on endometrial biopsy ● Endometritis/ Pelvic Inflammatory Diseases -As with endometrial carcinoma, may present with abnormal uterine bleeding -Unlike endometrial carcinoma, commonly associated with abdominal or pelvic pain, fever, chills, may occur because if sexually transmitted infection -Differentiated using history, physical examination, and microbiologic testing ● Cervical cancer -As with endometrial carcinoma, may present with abnormal uterine bleeding -Differentiated by abnormal appearance of the cervix or cervical mass on a speculum examination or colposcopy and by Pap cervical biopsy findings OR Clinical Key Endometrial Cancer
CAN USE other differential diagnoses in patients with abnormal uterine bleeding. Using the mnemonic PALM COEIN: ● Polyp ● Adenomyosis ● Leiomyoma (fibroid) ● Malignancy/hyperplasia ● Coagulation disorder ● Ovulatory dysfunction ● Endometrial (primary disorder of mechanisms regulating haemostasis) ● Infection/Iatrogenic (medications including HRT) ● Not yet known 4. Investigations ● Transvaginal Ultrasound -to look for endometrial thickness Endometrium <4 mm: cancer unlikely. No further investigation Endometrium >4mm: further evaluation ● Endometrial sampling using pipelle ● Dilatation and curettage under anaesthesia may be required if endometrial biopsy are negative in patients with persistent or recurrent symptoms ● Pap smear - TRO cervical cancer, may detect abnormal glandular cell ● Lab test: FBC, LFT, RFT , CA-125 to monitor recurrence ● Assessment for metastasis: Chest X ray, CT scan, MRI to look for extent myometrial invasion, lymph node metastasis Clinical Key Endometrial Cancer Gynaecology Ten Teachers, 20th edition, pages 207