Rectovaginal bimanual examination and to assess the uterus, cervix, adnexa, parametria, and the rectum is essential. Palpation of the inguinal lymph nodes and supraclavicular may reveal enlargement in advanced cases with metastatic disease. Histological evaluation of the endometrial tissue is needed. An endometrial biopsy can be performed safely and easily into the office environment in the most symptomatic patients. Several biopsy instruments are available for use, including pipelle sampler and Novak curette. Hysteroscopy and saline infusion sonography view endometrial lesions, such as polyps, inside the uterine cavity and can be a useful addition to sampling techniques of the endometrium.
If endometrial cancer is confirmed, further studies are needed to optimize treatment planning, including a chest x-ray to rule out metastatic disease. The treatment is based on the stage of the disease surgically fixed and evaluation of prognostic characteristics. The need for adjuvant therapy is based on disease stage and recurrence risk factors of the tumor. For disease confined to the uterus, patients are placed in lower categories, medium, and high risk, and adjuvant treatments are based on pathological features. In general, the stage I tumors that are superior and more deeply invasive in the myometrium have a greater risk of recurrence and benefit from postoperative adjuvant therapy.
Whole-pelvis radiotherapy, with or without vaginal cuff brachytherapy, postoperative adjuvant modality is the most commonly used treatment. Carcinoma patients with papillary serous histologic variant, an aggressive endometrial lesion with high risk of recurrence extrapelvic, are usually offered chemotherapy to reduce the risk of postoperative recurrence, although this treatment is controversial. For diseases involving the cervix, there are several treatment options. When the unexpected participation of cervical stroma is found during surgery, postoperative external radiotherapy with brachytherapy vaginal cuff is indicated. If the involvement of the cervix is known preoperatively, various combinations of surgery and radiation were used.
Hysterectomy, bilateral salpingo-oophorectomy, and node sampling followed by postoperative irradiation. Preoperative intracavitary radiation therapy and external beam followed by hysterectomy and bilateral salpingo-oophorectomy. Unfortunately, there is no standard treatment for stage ii endometrial cancer, and the equivalence of these strategies has not been evaluated in randomized controlled trials. Patients with para-aortic damage could benefit from an extension of the radiotherapy field.
Metastatic disease site and the symptoms associated with dictate the appropriate treatment of cancer of the endometrium of step iv. For large pelvic disease, radiation consisting of a combination of irradiation by intracavitary and external beam is used. When distant metastases are present, systemic therapy is indicated. useful chemotherapeutic agents include doxorubicin and paclitaxel. The five-year survival rates are much poorer in patients with tumor histologies less common and poorly differentiated. These patients often present with metastatic disease and a disproportionate number of deaths from endometrial cancer.
Step to the presentation and the relative survival rate at 5 years. Ovarian cancer is a heterogeneous group of malignant tumors that originate from different cell types that make up the organ. These cancers arise from the germinal epithelium lining the ovary. epithelial ovarian cancer can be divided into several types of histological cells. Serous, mucinous, endometrioid, clear cell, transitional and undifferentiated carcinomas. The risk increases epithelial ovarian cancer with age and occurs mainly in postmenopausal women.
These tumors are generally less aggressive and often produce steroid hormones, including estrogen, progesterone and testosterone. Some patients with hormone-producing tumors exhibit signs and symptoms of excess steroids, such as vaginal bleeding or hyperandrogenism.