Endometrial Cancer treated with Hysterectomy & Bilateral Salpingo-Oophorectomy
PACE Hospitals’ Oncology team successfully performed a total abdominal hysterectomy with bilateral salpingo-oophorectomy on a 68-year-old female patient with carcinoma of the endometrium.
Chief Complaints
A 68-year-old woman presented with the chief complaints of pain in the abdomen radiating to the lower back associated with intermittent vaginal discharge for one year at
PACE Hospitals, Hitech City, Hyderabad.
Medical History
The patient was a known case of diabetes mellitus and her current blood glucose levels were currently under control as she was on hypoglycaemic medications.
Diagnosis
Upon being admitted to PACE Hospitals, her general systemic examination was done, and the patient was found to be conscious and coherent, and her vitals were stable. On a detailed physical examination, she had abdominal pain radiating to her lower back and was also found to have vaginal discharge.
Upon evaluating the diagnostic investigations, the patient was diagnosed with carcinoma of the endometrium.
Endometrial cancer, otherwise called as
uterine cancer, develops in the lining of the uterus.
Treatment
After consultations with the consultant surgical oncologist, Dr. Ramesh Parimi, along with the consultant endocrinologist Dr. Tripti Sharma, it was determined that a total abdominal hysterectomy with bilateral salpingo-oophorectomy was the effective method for treating the patient with carcinoma of the endometrium.
Before moving on to the procedure, all necessary tests were performed, and clearances were obtained including a pre-anaesthetic checkup. The proposed surgical procedure of total abdominal hysterectomy with bilateral salpingo-oophorectomy involved removal of both ovaries and fallopian tubes. To rule out the possibility of metastatic spread of the cancer cells, a biopsy of the endometrium was collected during the surgery from four different areas and tested for its spread and the procedure was done without any complications.
Intraoperative Findings
The surgery was performed through a lower midline sub umbilical incision and by opening the peritoneum. There was no evidence of omental nodular involvement or pelvic extension. Pelvic nodes weren’t affected by the cancer cells and were found without ascites. During the surgical procedure, both fallopian tubes and ovaries (bilateral salpingo-oophorectomy) were removed alongside the uterus (hysterectomy). Sampling of bilateral pelvic nodes was done to understand the metastasis of cancer.
Postoperative Care
The post-operative period was uneventful. The patient was discharged when she was hemodynamically stable and was prescribed antibiotics, antipyretics, proton pump inhibitors, and vitamins.
Discharge Medications
At the time of discharge, the patient was prescribed Antibiotics, antipyretics, Proton pump inhibitors (PPIs) and instructed to continue oral hypoglycaemic drugs as per the prescription.
Emergency Care
The patient was informed to contact the Emergency Ward at PACE Hospitals in case of adverse symptoms like fever, abdominal pain, or vomiting.
Review notes
The patient was asked to get a review done by Dr. Ramesh Parimi with a prior appointment after 1 week.
Role of TAH with BSO in Endometrial cancer
Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH+BSO) is a surgical approach used to remove endometrial cancer tumors and prevent disease progression. It eliminates estrogen sources, which are key drivers in hormone-dependent endometrial cancers. TAH+BSO aids in accurate disease staging, determining the need for adjuvant therapies like radiation or chemotherapy. In high-risk cases, pelvic and para-aortic lymphadenectomy are performed to assess metastatic spread. TAH+BSO is especially important for non-endometrioid histology with deep myometrial invasion, and hereditary cases like Lynch syndrome. It is generally recommended for postmenopausal women, but younger patients may consider fertility-preserving alternatives like progestin therapy. In advanced-stage endometrial cancer, TAH+BSO is often part of a multimodal treatment strategy involving chemotherapy and radiation for optimal disease control.
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