Pap Smears Have Played a

¶ … Pap smears have played a vital role in the decrease of cervical cancer incidence and mortality [LAZCANO 2008]. The test itself, however, is highly subjective with a limited sensitivity of 50% along with a number of inherent individual variability [BOULET et al. 2008]. This limited sensitivity extends to other cancers including endometrial adenocarcinoma. This particular type of cancer is the most common gynecologic cancer diagnosed in the United States, affecting postmenopausal women predominantly [COHN et al. 2006].

With the case study purporting the existence of abnormal cells diagnosed as endometrial adenocarcinoma; it is safe to assume that the woman in question was experiencing other symptomology. Endometrial cancer develops within the lining of the uterus, known as the endometrium, which thickens monthly in preparation for pregnancy and shed subsequently during menstruation [AMANT et al. 2005]. Three types of endometrial cancer exist: adenocarcinoma, papillary serous carcinoma, and clear cell adenocarcinoma [AMANT et al. 2005].

The cause of endometrial cancer is unknown, but there are a number of risk factors associated with the disease which may point to an oncogenic source including hormone levels, which in peri and postmenopausal women can fluctuate towards increased estrogen production which has been linked to cancer [AMANT et al. 2005]. Additional risk factors include increasing age, metabolic syndromes like obesity and diabetes, long-term use of tamoxifen, hormone replacement therapy, as well as having a first degree relative afflicted with the disease [AMANT et al. 2005].

Adenocarcinoma develops predominantly on the surface of the endometrium and account for 90% of all cases, with abnormal bleeding presenting as a symptom [LEITAO JR et al. 2009]. A known precursor to adenocarcinoma is endometrial complex atypical hyperplasia (CAH) which carries a 25% chance of oncogenesis [RUBATT et al. 2005]. The treatment for CAH, as with adenocarcinoma, is usually hysterectomy, although it can benefit from progestational treatment [RUBATT et al. 2005]. Management of CAH is difficult due to the inherent inconsistencies of the lesions classification, natural history, and histologic diagnosis [IZADI-MOOD 2009].

The patient in question will need a further endometrial sampling analyzed and given an International Federation of Gynecology and Obstetrics (FIGO) score, usually through a biopsy under anesthesia called a D&C [LEITAO et al. 2009] with an adenocarcinoma appearing as squamous differentiation [AMANT et al. 2005]. If the cancer is localized the course of treatment will likely be hysterectomy and bilateral salpino-oophorectomy, with the best results obtained by concurrent radiation therapy if there is a deep invasion of the myometrial muscle [KEYS et al. 2004].

Within the pathology of endometrial adenocarcinoma, it is the presence of strong tumor differentiation involving the upper 66% of the corpus along with negative peritoneal cytology and no vascular space invasion that requires a total hysterectomy along with the removal of pelvic lymph nodes [ELTABBAKH et al. 1997]. Presence of regional and distant metastases alters the stage of the disease and for these patients, standard therapy is inadequate [KEYS et al. 2004].

With the diagnoses of endometrial adenocarcinoma it is most likely that the patient in question is at an early stage of disease. To have a better prognosis, further surgical diagnosis to achieve a FIGO stage is needed as that will allow doctors to ascertain the level of myometrial muscle invasion, histological type, and differentiation grade [AMANT et al. 2005]. If the patient is at a FIGO stage one, the five-year survival rate stands at 85%, with stage II standing at 75%, stage III at 45%, and stage IV at 25% [GRISBY et al. 1992].

Treatment should follow the established regimen of hysterectomy along with radiation therapy. References Amant, F. et al. 2005. Endometrial Cancer. Lancet, 366, pp. 491-505. Boulet, G.A.V., et al. 2008. Human Papillomavirus in Cervical Cancer Screening: Important Role as Biomarker. Cancer Epidemiology, Biomarkers, and Prevention, 17(4), pp. 810-17. Cohn, D.E. et al. 2006. Advanced endometrial cancer with serious metastasis in a 17-year-old. Gynecologic Oncology, 101(2), pp. 256-59. Eltabbakh, G.H. et al. 1997.

Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without.