Clinicopathological Analysis of Carcinoma Endometrium at a Tertiary Care Centre in Chennai – A Retrospective Study

BACKGROUND Endometrial carcinoma is a leading malignancy among females. Pre-operative imaging and biopsy are necessary to identify the disease. Clinicopathological analysis determines the extent of the disease. Complete surgical staging is advised for high-risk patients. The purpose of this study was to analyze the different clinical endpoints, prognostic factors and demographic details that will influence the survival patterns of the cases of carcinoma of endometrium who underwent surgery during the period from 2014 to 2017 at a tertiary care centre, Chennai, India. METHODS Patients diagnosed with operable endometrial carcinoma were surgically staged based on the surgical procedures performed namely, total abdominal hysterectomy (TAH) with bilateral salphingo-oophorectomy (BSO), bilateral pelvic lymph node dissection, and para-aortic lymphadenectomy (patients with high-risk features). Post-surgical staging specimens were histopathologically examined in the Department of Pathology. Adjuvant radiation was given to patients with stage IA grade II and above. Patients with stage III disease received adjuvant chemotherapy. Descriptive analysis was done to show the distributions of patients accordingly. Kaplan-Meier survival analysis was performed for the overall median survival of the patients. RESULTS The study consisted of a total of 35 patients with a mean age of 56 ± 8.64. Parameters such as age, clinicopathological features, stage (FIGO staging), tumor size, grade, lymphovascular invasion (LVI), myometrial invasion, cervical involvement, involvement of margins, lymph node ratio (LNR) and survival were studied. Tumor size and grade were found to be significant factors affecting the survival. Overall median survival period of patients who underwent surgery was found to be 31 months. CONCLUSIONS Tumor size and grade of the tumor are significant prognostic factors affecting the survival of the patients with carcinoma of endometrium. Lymph node ratio is a new concept in carcinoma endometrium to be pondered upon as a factor predicting survival in future studies thereby defining the role of lymph node dissection in surgical staging. KEYWORDS Endometrial Cancer, FIGO Staging, Lymph Node Ratio, Prognosis, Survival Analysis

Clinicopathological analysis of AUB in perimenopausal and postmenopausal women in cancer care centre: special reference to carcinoma endometrium

Background: Abnormal uterine bleeding (AUB) may be defined as any variation from normal menstrual cycle including alteration in its regularity, frequency, duration of flow and amount of blood loss. Postmenopausal bleeding is a danger sign for malignancy. The study aimed to study the histopathology spectrum of hysterectomy specimens and bleeding patterns in perimenopausal women and postmenopausal women.Methods: It was a retrospective observational study done at Government Medical College and Cancer Hospital, Aurangabad (MS) from January 2017 to January 2021. Total sample size was 100 women. Perimenopausal and postmenopausal women undergoing hysterectomy were analysed for the age, parity, etieology, histology and the malignant changes.Results: 22 cases of AUB were observed in the age group of less than 40 years. 56% cases presented with heavy menstrual bleeding 58% cases had prolonged menstrual bleeding. 36% cases had endometrial cause (harmonal disturbances), 12 % had endometrial polyp and 35 cases out of 100 had endometrial carcinoma. Both type 1 and type 2 cases of carcinoma endometrium are seen in this study.Conclusions: Excessive uterine bleeding is a common gynaecological problem in all age groups with significant patient morbidity. The spectrum of endometrial lesions seen in AUB and cancer cases shows that the histopathological examination of endometrium is gold standard diagnostic tool in evaluation of AUB and postmenopausal bleeding and there is an age specific association of endometrial lesions.

RETROSPECTIVE EPIDEMIOLOGICAL STUDY OF CARCINOMA ENDOMETRIUM – AN INSTITUTIONAL EXPERIENCE

Background: Carcinoma Endometrium is one of the most common cancers of women in developed countries and third most common cancer of female genital tract cancers in developing countries following carcinoma cervix and carcinoma ovary. Objective: The present study was undertaken to investigate the epidemiological factors of patients with carcinoma endometrium. This study involves correlation of various factors such as age related distribution, risk factors associated, histopathological differentiation, common symptoms and the staging of the disease. Materials and Methods: This is a retrospective study done in department of Radiotherapy, Stanley Medical College and Hospital, Chennai involving patients with Carcinoma Endometrium treated during 2013 to 2017. Results: Majority of the patients belong to 41 – 50 yrs of age group (i.e) 4th decade followed by 3rd decade. All of them were in good performance status with ECOG score 1-2. The cancer was almost equal in both premenopausal age group (44%) and postmenopausal age group (50%) respectively. The predominant histopathology noted was endometrioid carcinoma( 91%.). Conclusion: Most of the patients were in stage III followed by stage II. Early detection of patients with carcinoma endometrium with effective screening methods play a vital role in increasing disease free survival, progression free survival and overall survival.

Re-staging surgery in endometrial cancer: an audit on its value

Background: Incomplete surgical staging in carcinoma endometrium is not an uncommon entity in developing world. Proper surgical staging has got a role in prognostication and planning adjuvant treatment. So, an audit was done to assess the extent of upstaging in women with endometrial cancers who were referred to index centre from outside hospitals with incomplete surgical staging.Methods: It is a retrospective study. The demographic, clinical and treatment details of women with complete data having at-least one follow up after completion surgery were analyzed. Patients who had any other anticancer treatment elsewhere were excluded. The extent of upstaging was studied based on International federation of gynecology and obstetrics (FIGO) 2008 staging.Results: A total of 88 patients of endometrial cancer were evaluated retrospectively, of which 10 had completion surgery. 10% of the patients were upstaged according to the FIGO stage (one from IA to IB), while one patient upstaged from IIIA to IVB after slide review by index centre. According to FIGO Grade, 40% patient upgraded (one upgraded from I to II, three from II to III) while one downgraded from II to I. Recurrence rate was 40%.Conclusions: Upstaging is seen in 10% of patient after completion surgery, which requires the necessity of evaluation by gynecologic oncologist selectively. However, larger and multi-centric studies needed to draw definite conclusion. There is a significant discordance in grade and histology after the review at index centre.