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Prevalence of endometrial cancer in symptamatic women with thickened endometrium

Dr Maheswari SRINIVASAN MRCOG SpR, Mrs Shagaf BAKOUR FRCOG Consultant Obs & Gynae.City Hospitals, Sandwell and West Birmingham NHS trust, Birmingham

Objectives

Back ground-

•Endometrial cancers are the most common gynaecologic

cancers.

•Incidence of endometrial cancer is on the rise due to increase in

obesity in the world.

•Endometrial cancer predominantly occurs in the perimenopusal

and post menopausal women with thickened endometrium.

•Risk factors include postmenopausal oestrogen therapy,

obesity, a high-fat diet, reproductive factors like nulliparity, early

menarche and late menopause, polycystic ovarian syndrome,

and tamoxifen use

•10% of symptomatic women with thickened endometrium will

have endometrial carcinoma.

•The main objective of the diagnostic evaluation of women with

postmenopausal vaginal bleeding is exclusion of malignancy.

•Transvaginal ultrasound is a cost-minimizing screening tool for

postmenopausal women with vaginal bleeding.

•Endometrial polyps are often diagnosed with transvaginal

ultrasonography while in some occasions it might be bit difficult.

•Saline sonography helps in the better detection of endometrial

polyps.

Aim

•To ascertain the pick up rate of endometrial cancer in women attended the Post Menopausal Bleeding clinic with Postmenopausal bleeding and thickened endometrium.

•To ascertain the prevalence of other pathology (polyps) in the same cohort of women

Methods

Materials and Methods:-

•Post menopausal clinics are in operation in our trust.

•Retrospective review of the case notes of women who

attended with symptoms of post menopausal bleeding over 3

year period from Jan 2008 until Dec 2010.

•There were 56 clinics

•262 patients were identified and analysed.

•All women with symptoms of post menopausal bleeding

underwent transvaginal scanning.

•Women with thickened endometrium of more than 4mm

underwent endometrial pipelle biopsy.

•The number of women diagnosed with endometrial cancer

underwent surgical management in the form of total abdominal

hysterectomy and bilateral salphingo oophorectomy.

…

Results

• 56 clinics

• 262 women attended.

• 101 women had thickened endometrium ET > 4 mm.

• Endometrial pipelle samples and further investigations

were carried out in these women.

• 13 patients were HRT users

• .16 patients were on Tamoxifen.

• Age range-47-91 yrs

• Ten women were diagnosed with endometrial cancer

(10% incidence).

• Three had cervical cancer.

• Seven women were diagnosed with complex hyperplasia

in the initial pipelle sample, of which endometrial cancer

was present in 4 women.

• 21 patient had sonographic findings suggestive of

endometrial polyp of which 12 confirmed by the gold

standard (hysteroscopy) (57%)

Conclusions

References

• 10% of women with thickened endometrium turned

out to have endometrial cancer this correlates to

the international observational studies.

• 56% of women with suspected endometrial polyps

were confirmed by hysteroscopy.

• None of the women with endometrial thickness less

than 4 mm found to have carcinoma.

OPTIONALLOGO HERE

OPTIONALLOGO HERE

• Ultrasonographic evaluation of the endometrium in postmenopausal vaginal bleeding-Davidson KG, Dubinsky TJ.Department of Anesthesiology, University of Iowa Hospitals and Clinics, 6 JCP, Iowa City IA 52242, USA. Radiol Clin North Am. 2003 Jul;41(4):769-80

• Transvaginal sonography combined with saline contrast sonohysterography to evaluate the uterine cavity in patients with abnormal uterine bleeding and postmenopausal endometrium more than 5 mm. Kazandi M, Akşehirli S, Cirpan T, Akercan F. Eur J Gynaecol Oncol. 2003; 24(2):185-90.

• Endometrial polyps in postmenopausal women.• Domingues AP, Lopes H, Dias I, De Oliveira CF. Acta Obstet

Gynecol Scand. 2009; 88(5):618-20. …