This document discusses the medical treatment of endometrial hyperplasia and endometrial cancer. It provides information on diagnosis, treatment recommendations, staging, and prognosis. For endometrial hyperplasia with atypia, hysterectomy is the treatment of choice for women who don't want future pregnancies. Progestin therapy can treat hyperplasia without atypia. The most common symptom of endometrial cancer is vaginal bleeding or discharge. Staging and grading help determine prognosis and treatment. The cornerstone treatment is hysterectomy and bilateral salpingo-oophorectomy. Follow up care is important to monitor for recurrence.
this lecture for undergraduates, GP & gynecologists
it includes full simple explanation of CIN (cervical intraepithelial neoplasia)
how to do screening for cervical cancer
methods of screening that include pap smear and HPV testing
it also includes the diagnostic method for the cervical cancer by taking biopsy directed by colposcopy
colposcopy and its rule
how to deal with CIN different grades
follow up after CIN treatment
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
this lecture for undergraduates, GP & gynecologists
it includes full simple explanation of CIN (cervical intraepithelial neoplasia)
how to do screening for cervical cancer
methods of screening that include pap smear and HPV testing
it also includes the diagnostic method for the cervical cancer by taking biopsy directed by colposcopy
colposcopy and its rule
how to deal with CIN different grades
follow up after CIN treatment
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Borderline ovarian malignancy, also known as borderline ovarian tumor or ovarian tumors of low malignant potential (LMP), is a distinct category of ovarian tumors that fall between benign and malignant tumors in terms of their behavior and potential for spreading.
Characteristics and Diagnosis:
Histological Features: Borderline ovarian tumors have certain cellular abnormalities that suggest malignancy but lack the invasive qualities seen in fully malignant tumors.
Age Group: They often occur in women of childbearing age, and their incidence tends to be highest in women in their 30s and 40s.
Clinical Presentation: Borderline ovarian tumors may be asymptomatic or present with nonspecific symptoms like abdominal pain, bloating, or changes in urinary habits.
Imaging and Biopsy: Diagnosis typically involves imaging studies, such as ultrasound, and a biopsy or surgical removal of the tumor for a pathological examination to confirm its borderline nature.
Treatment and Prognosis:
Surgical Approach: The primary treatment for borderline ovarian tumors is usually surgery, which involves removing the affected ovary or ovaries. The goal is to perform a comprehensive surgical staging to assess the extent of disease without removing both ovaries unless necessary.
Chemotherapy: Unlike malignant ovarian tumors, borderline tumors are less likely to spread beyond the ovaries. In cases where there is evidence of disease spread or in certain high-risk situations, chemotherapy may be considered.
Prognosis: The overall prognosis for women with borderline ovarian tumors is generally favorable. The majority of patients have an excellent long-term survival rate, especially if the tumor is confined to the ovaries at the time of diagnosis.
Follow-Up and Recurrence:
Regular Monitoring: Given the potential for recurrence, patients with borderline ovarian tumors often undergo regular follow-up examinations, including imaging studies and blood tests (such as CA-125), to monitor for any signs of disease recurrence.
Reproductive Considerations:
Fertility-Sparing Options: For women who wish to preserve fertility, there may be options for fertility-sparing surgery in carefully selected cases where the tumor is unilateral, well-staged, and the patient desires future childbearing.
Conclusion:
Borderline ovarian malignancy represents a unique category in ovarian tumors, requiring a multidisciplinary approach involving gynecologic oncologists, pathologists, and other healthcare professionals. While generally associated with a favorable prognosis, individual cases can vary, and personalized treatment plans are essential for optimal outcomes. Regular follow-up and clear communication between patients and healthcare providers play a crucial role in managing and monitoring borderline ovarian tumors.
Embracing GenAI - A Strategic ImperativePeter Windle
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Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
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Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
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2-medical treatment of endometrial hyperplasia and endometrial cancer
1. Medical Treatment of
Endometrial Hyperplasia
And
Endometrial Cancer
May /14/2015
Hatim Al-Dabbagh MBBS.FRCSC
Gynecologic Oncologist
Dhahran Health Center
Johns Hopkins Aramco Healthcare
3. Endometrial Hyperplasia
It represents a spectrum of morphologic and
biologic alterations of the endometrial
glands and stroma, ranging from an
exaggerated physiologic state to carcinoma
in situ
It results from protracted estrogen stimulation
in the absence of progestin influence
4. Endometrial Hyperplasia
The risk of endometrial hyperplasia
progressing to carcinoma is related to the
presence and severity of cytologic atypia
Progestin therapy is very effective in
reversing endometrial hyperplasia without
atypia but is less effective for endometrial
hyperplasia with atypia
5. Diagnosis
Office endometrial aspiration is the first step in
evaluating a patient with abnormal uterine
bleeding
The diagnostic accuracy of office-based endometrial
biopsy is 98%
A critical review of 33 reports of 13,598 D&Cs and
5851 office biopsies showed that D&C had a
higher complication rate than office biopsy but
that the adequacy of the specimens was
comparable
6. Diagnosis
If the initial biopsy result is negative, further
evaluation is recommended in patients with
persistent symptoms, due to the high risk
(11%) of an existing lesion having been
overlooked
Feldman S, gynecol Oncol, 1994;55:56-9
7. Diagnosis
Endometrial thickness of less than 4mm as
measured by ultrasonography is highly
suggestive of endometrial atrophy
(sensitivity 96-98%, specificity 36-68%,
false negative rate 0.2%)
8. Endometrial Biopsy
Safe, relatively simple procedure useful in
perimenopausal or high risk women
Not sensitive for detecting structural abnormalities
(eg, polyps or fibroids)
Office-based techniques (gold standard replacing
D&C
Disposable devices (eg, Pipelle, Tis-u-Trap, Accurette, Z-
sampler)
Reusable instruments (eg, Novak Curette, Randall
Curette, Vabra Aspirator)
9. Possible Endometrial Biopsy
Findings
Proliferative, secretory, benign, or atrophic
endometrium
Inactive endometrium
Tissue insufficient for analysis
No endometrial tissue seen
Simple or complex (adenomatous) hyperplasia
without atypia
Simple or complex (adenomatous) hyperplasia with
atypia
Endometrial adenocarcinoma
11. SUMMARY AND
RECOMMENDATIONS
Hysterectomy is the treatment of choice for women with
endometrial hyperplasia with atypia who are not planning future
pregnancy.
For postmenopausal women with atypical hyperplasia,
Hysterectomy with concomitant bilateral salpingo-oophorectomy
(BSO) rather than hysterectomy alone is the right choice.
For premenopausal women undergoing treatment with
hysterectomy, BSO remains controversial.
.
12. Progestin therapy is an option for women with atypical
endometrial hyperplasia who wish to preserve fertility or who
cannot tolerate surgery. Oral Megestrol acetate 80 mg twice
per day every day. This may be increased to 160 mg twice per
day if there is no regression of the hyperplasia on follow-up
endometrial sampling.
Approximately 35 percent of women will fail conservative
management.
Progestins rather than surgery for treatment of endometrial
hyperplasia without atypia is the rigt choice.
Medroxyprogesterone acetate 10 mg daily for three to six
months. Other progestin preparations may also be used.
Observation with follow-up sampling, especially for simple
hyperplasia without atypia, is also reasonable, especially in
patients who cannot tolerate progestin therapy
15. Endometrial Carcinoma
• Stereotyped as a disease of the obese
patient and the disease usually proceeds
through a precursor of endometrial
hyperplasia
• Such tumors have endometrioid histology
and are usually of early stage and low
grade
16. Endometrial Carcinoma
• However, such a stereotype does not
account for many endometrial cancers
• Nonendometrioid histologies include
papillary serous & clear cell carcinomas
17. Symptoms of Endometrial
Cancer
90% of women have vaginal bleeding or
discharge as their only presenting complaint
Less than 5% of women diagnosed with
endometrial cancer are asymptomatic
19. Postmenopausal Bleeding
60-80% of patients with postmenopausal
bleeding have endometrial atrophy
Only about 10% of the patients have
endometrial cancer
The older the patient is, the greater the risk of
cancer
20. Endometrial Carcinoma -
Natural History
• Most common route of spread is direct
penetration of the myometrium and direct
extension into the cervix and endocervix; tumor
may also gain access to lymphatic spaces
resulting in nodal metastases
• Endometrial cancers may spread to pelvic
lymph nodes, as well as the paraaortic chain
21. Endometrial Carcinoma -
Natural History
• The occasional presence of malignant cells in
peritoneal washings demonstrates the potential
for transtubal migration of disease
• Hematogenous spread can result in distant
disease
• Tumors with clear cell & papillary serous
histology are biologically more aggressive than
typical endometrioid carcinomas
22. Endometrial Carcinoma -
Staging
• Staging of endometrial cancer is surgical
• Grade is assessed by the percentage of
solid growth pattern
23. Endometrial Carcinoma -
Grading
• G1 = <5% of a nonmorular, solid growth
pattern
• G2 = 6% to 50% of a nonmorular, solid growth
pattern
• G3 = > 50% of a nonmorular, solid growth
pattern
24. Endometrial Carcinoma -
Grading
• Papillary serous, clear cell and
adenosquamous carcinomas are graded
according to the nuclear grade of the
glandular component
25. Staging of Corpus Cancer
• Stage IA Tumor limited to
Endometrium or Invasion to < 1/2 of
myometrium
• Stage IB Invasion of > 1/2 of
myometrium, but not to serosa
27. Staging of Corpus Cancer
• Stage IIIA Tumor invades serosa, and/or
adnexa, and/or + peritoneal cytology
• Stage IIIB Vaginal metastases
28. Staging of Corpus Cancer
• Stage IVA Tumor invasion of bladder
and/or rectal mucosa
• Stage IVB Distant metastases -
intraabdominal contents or inguinal
nodes
29. Carcinoma of Endometrium -
Stage Distribution
• Stage I - 72.8%
• Stage II - 10.9%
• Stage III - 13.2%
• Stage IV - 3.1%
– J Epidemiol Biostat 3:35, 1998
30. Endometrial Carcinoma -
Treatment
• The cornerstone of treatment is total
abdominal hysterectomy and bilateral
salpingo-oophorectomy
• This operation should be performed whenever
possible
• Some patients require sampling of the regional
(pelvic & paraaortic) lymph nodes as based on
the pathologic information available
31. Endometrial Carcinoma -
Treatment
• Patients with stage III and IV disease
require individualization as to therapy -
this often involves radiotherapy and
surgery in selected cases
32. Endometrial Carcinoma -
Prognostic Factors
• Tumor Stage
• Grade/Histologic type
• Depth of Invasion
• Peritoneal cytologies
• Receptor status (ER/PR)
• Patient age
• Vascular space invasion
• DNA Ploidy
33. Follow-up of Affected Patients
• Patients seen every 3-4 months for first
two years
• Seen every 6 months thereafter until 5
years after treatment
• Seen yearly thereafter
• Majority of recurrences found by
symptoms, exam, CXR and Pap smear
34. Recurrent Disease
• Approximately three quarters of patients who
experience recurrence will do so in the first
three years after primary therapy
• Isolated vaginal metastases are the most
amenable to therapy
• Patients with vaginal metastases should be
evaluated to rule out further metastatic spread