Endometrial Cancer

Option List:
A. Laparoscopically assisted vaginal hysterectomy
B. Radical hysterectomy, radiotherapy and chemotherapy
C. External radiotherapy
D. TAH, BSO, peritoneal cytology, omentectomy, pelvic para-aortic lymphadenectomy.
E. Laparoscopic hysterectomy with bilateral salpingectomy
F. Laparotomy and bilateral salpingo-oophorectomy (BSO)
G. Presurgical radiotherapy followed by completion hysterectomy
H. Chemoradiation
I. Palliative care
J. Total abdominal hysterectomy (TAH) with BSO,
K. Tamoxifen
L. Progesterone
M. Annual follow-up
N. Optimal debulking surgery
O. Combined surgery and chemotherapy
P. No further therapy
Q. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy
For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

1. A 52-year-old P1 woman was referred to the gynaecology clinic with irregular vaginal bleeding and abdominal pain lasting 2 months. Pelvic ultrasound showed an enlarged uterus with 13 mm thick endometrium and a10 cm complex adnexal mass on the right side. Outpatient Pipelle sampling has shown well-differentiated endometroid adenocarcinoma cells. Subsequent MRI has shown a three-quarters myometrial invasion. What is the most appropriate option?

2. A 40-year-old parous woman underwent simple hysterectomy with ovarian conservation for severe menorrhagia. Later histopathological examination has shown a well-differentiated endometrial adenocarcinoma limited to the endometrium. What is the appropriate next step?

3. A 35-year-old lady has been seen in the gynaecology clinic with irregular vaginal bleeding for the past 2 months. She has previously been diagnosed with breast cancer and has been on tamoxifen for 4 years. Pelvic ultrasound was normal and outpatient hysteroscopy and biopsy of endometrium done. Histology of the endometrial sample has shown atypical endometrial hyperplasia.

4. A 51-year-old lady undergoes outpatient hysteroscopy and endometrial sampling for postmenopausal bleeding. Histopathological examination has shown well- differentiated adenocarcinoma cells. A subsequent magnetic resonance imaging (MRI) scan has shown a right lateral uterine wall growth limited to the inner one third of the myometrium. The uterus is found to be of normal size. What is the next step?