Abstract

Background: It is believed that because of abnormal uterine bleeding (pre-, peri-or postmenopausal), most constant first symptom of endometrial cancer, care is usually sought early. But in developing countries this may not happen. Also while most of often EC occurs in postmenopausal women, mostly 61-70yrs, some might get it at younger age with challenges in management. Objectives: Present study was conducted to look at challenges in management of EC in women from low resources. Material Methods: Present study was conducted in the department of Obstetrics & Gynecology of a rural tertiary care centre after approval of ethics committee of the institute with help from pathology. Histopathologically proved EC cases managed over a period of 9 years were included and details of their management were analyzed. Results: Of the 62 patients of EC, 11 (17.74%) were premenopausal and 51 post-menopausal, 57 (91.94%) were of Type I 5 (8.06%) Type II. Fifty-four (93%) out of total 62 women could be evaluated completely surgically also, with available facilities and had myometrium involvement diagnosed on histopathology, 4 only by imaging. Nineteen women had one third thickness, 12 half thickness, 2 two third thickness, 21 had full thickness of uterine myometrium involvement. Peritoneal washings were submitted for cytology only in 8 patients, 4 (50%) were positive for EC, Two of those 4 had tubectomy years back. All four had myometrium involvement of more than half thickness. Of 4 cases with negative washings, 3 had tubectomy and no myometrium involvement. Out of 34 cases in whom lymph nodes were submitted, three (8.8%) had positive lymph nodes and had half to full thickness myometrium involvement on histopathology. All 4 patients of less than 40 years were of Type I EC, 3 stages I and one stage III. All had surgery, followed by chemo radiotherapy. Overall of the 62 patients of EC, 18 (29.03%) were of stage I A, 20 (32.26%) stage I B, 4 (6.45%) Stage II, 6 (9.68%) stage III A, 3 (4.84%) stage III B, 3 (4.84%) stage III C, (12.9%) were stage IV B. So over all 50% were beyond stage I, almost 18% stage III. Conclusion: In resource poor women in whom EC is increasing, are not being diagnosed in early stages with limitations in availability and use of technology available. Peritoneal cytology and linkage of myometrium histopathology and also myometrium involvement and lymph node involvement need more research.