Rekha a 45 years old woman has negative pap smear with +ve endocervical curretage. Next step in management will be :
Correct Answer: Weheim's hysterectomy
Description: Ans. is d i.e. Weheim's hysterectomy A 45 year old woman i.e. (perimenopausal female) with negative pap smear (i.e Ca cervix excluded) with positive Endocervical curettage points towards cancer Endometrium which has spread to cervix i.e. (if you remember the staging which I have given in answer 12) - Stage II. Approaches for Management of Stage - II Ca endometrium : Remember : All women with endomtrial cancer should undergo hysterectomy. BSO and surgical staging using a FIGO system. Only a few circumstances contraindicate primary surgery and these conditions are : Desire to preserve feility masive obesity high operative risk Clinically unresectable disease 1st approach (+Surgery) hod approach (Surgery+) Brachytherapy followed by : Weheim's (Modified Radical TAH + BSO hysterectomy) Hysterectomy + /- External radiotherapy 14% as per histological findings Also know : Indications of vaginal hysterectomy in a case of Carcinoma Endometrium. .. Novak 13/e, p 1165 Obese patient (making Abdominal hysterectomy difficult to perform). Poor medical status. Extensive utero vaginal prolapse. Disadvantages of Vaginal Route are : Bilateral salpingo-oophorectomy is difficult to perform. Abdominal exploration and lymph node sampling cannot be done. Extra Edge : It is very difficult to remember the different types of hysterectomies and what structures are removed in them therefore I am briefing down impoant ones for you. Do go through them, they will be quite helpful for all of you.
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Gynaecology & Obstetrics
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