PMB/EAC

Question 1

Workup for PMB

Scenario 1 - std presentation

Scenario 2- PMB in setting of HRT or TMx

Answer 1

DDx
- atrophy
- polyp
- fibroid
- cervical
- EH/AH/EAC

Ix
- FBE/UEC/LFT/HbA1c +/- CA125
- Pelvic USS
+/- Pipelle -> Cat 1 HDC

Initial Mx pending histo
- cease HRT/TMx pending further mx
- +/- non-hormonal VMS mx options
- W/L for HDC
- HDC consent
1. indication
2. procedure
3. analgesia - regional vs GA
4. risks
5. follow-up
6. alternatives

Question 2

Counsel someone re: tamoxifen and EAC risk

Answer 2

• reduce BCA risk > small risk of EAC
• no evidence for surveillance
• if sx -> stop & investigate (pelvic USS)
• max 10 years

Question 3

Mx of EAC following initial Ix

Scenario 1 - low grade EAC on curette

Scenario 2 - EAC on cytology

Answer 3

• risk of locoregional spread if no rx
• MRI (myoinv/region)/CXR(met)/CA125
• Refer Tert GONC
• GONC MDT rv…
• Hyster+BSO+SLND
• early stage = good prog up to 90% 5-yr
• may need adjuvant RT
• MDI - surg/ano/med
• SPAC - optimization/baseline ix
• Postop - MDT, F/U, GONC surveillance

Question 4

Counsel pt diagnosed with advanced EAC re: treatment (primary CCRt)

Answer 4

• stage III/IV unresectable
• risk of mets - deterioriate/sx
• GONC MDT
• MDI - MONC/Rad Onc/Palliative
• likely need chemo +/- VBT
• Chemo - neuropathy/infection/alope
• RT - ‘itis’ cystitis/colitis/proctitis/vaginiti