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Re: Atypical complex hyperplasia / endometrial cancerFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Fri Feb 21 05:12:14 2003
For pt # 1 I would follow her with endometrial biopsies every 6-12 months, my local experience with TVUS is not good with way to many false positives ( a very high false positive is expected but I think I am being referred more false positives than is reasonable). I would make sure she understands this is a precancerous lesion and can progress to cancer, if she finds this unacceptable then I would do a hyst. If she chooses to be followed she needs high dose progesterone with follow up biopsy in 3-6 months. For patient # 2 the if I am confident it is well diff adeno, then I would base the decision on the type of hyst on the usual surgical considerations. There is an argument that sampling pelvic and Para aortic nodes that are not clinical positive adds significant morbidity with almost no survival benefit for little enhanced prognostic evidence. For a Canadian prospective from the B.C. cancer agency. http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Gynecology/Endometrium/default.htm
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Take care, John
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