Diagnosis

1. Fr D&C + cervical biopsy

2. Hysteroscope directed biopsy

Risk factor

1. Obesity

2. Nulliparity

3. Late menopause

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Stage       Ia G123      Tumor limited to endometrium

                Ib G123      Invasion of less than half of the myometrium

                Ic G123      Invasion of more than half of the myometrium

               IIa G123     Endocervical glandular involvement only

               IIb G123      Cervical stromal invasion

              IIIa G123      Tumor invades serosa ¡B adnexae ¡B positive cytology

              IIIb G123      Vaginal metastases

              IIIc G123      Metastases to pelvic and/or paraaortic lymph nodes

              IVa G123      Tumor invasion of bladder and/or bowel mucosa

                      IVb      Distant metastases ¡B inguinal lymph node

Histopatholgoy:  Degree of differentiation 

Cases of carcinoma of the corpus should be grouped according to the degree of differentiation of the adenocarcinoma as follows:

G1 = 5% or less of a nonsquamous or nonmorular solid growth pattern

G2 = 6% to 50% of a nonsquamous or nonmorular solid growth pattern

G3 = more than 50% of a nonsquamous or nonmorular solid growth pattern

Pre-operative survey

1. Sonography

2. Abdomino-pelvic CT
3. MRI (optional)

4. IVP

5. LGI 

Primary treatment

1. Comprehensive surgery

washing cytology + ATH (or Extended ATH) + BSO + Bilateral pelvic lymph node dissection + paraaortic LN sampling analysis (when Gr3 or deep myometrial involvement)

2. specimen sent for hormone receptor and flow cytometricDNA ploidy

Risk factor (indicators for post-operative therapy)

1. Histologic differentiation

2. Stage of disease

3. Myometrial invasion

4. Peritoneal cytology

5. Lymph node metastasis

6. Adnexal metastasis

7. Hormonal receptor

8. DNA ploidy

Adjuvant therapy

1. Radiotherapy:

a. whole pelvis with/or without vaginal brachytherapy

b. whole pelvis + entended PA field

2. Chemotherapy:

a. splatin, adriamycin, epirubicin, paciltaxel

3. Hormone therapy:

a. megestrol acetate: 160 mg/d-320 mg/d

b. tamoxifen: 20-60 mg/d

c. GnRHa: Lupron depot 3.75 mg SC/month