Endometrial Cancer

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Endometrial Cancer

A) Please fallow instruction. I need you to make up a soap note for a female patient diagnose with of Endometrial Cancer. Please fallow the format of the sample or template, which I sent to you as an attachment. Please fill out the template completely using your own words for the assessment finding. I included the soap note template you must plug the information, the rubric to follow in separate attachments. I need you to provide the following: APA format with 5 references at least no older than 5 years.

1) The Diagnosis ICD 10 code

2) 3 differential diagnoses with ICD 10 code describe and discuss

3) Complete vital sign, BMI

4) Complete Chief compliant of patient

5) Subjective Information

6) PMH, PSH, FH, ROS completed. Provide complete and concise summary of pertinent information.

7) Complete Objective Information

8) Lab Tests

9) Allergies

10) Complete physical exam with critical elements related to subjective data.

11) Perform Assessment

12) Minimum of 3 differentials supported by S + O data. Final diagnosis noted and optimal and thorough subjective and objective assessment is presented for final diagnosis.

13) Create a Plan

14) Plan includes pharmacologic and nonpharmacologic treatments as well as education provided. The plan is supported by evidence/guidelines, and the follow-up plans are noted.

15) Self-Assessment & Clinical Guidelines

16) Analyze quality and relevance of S + O data and the evidence for diagnosis. Use of clinical evidence based reasoning and literature in designing plan of care, compare to plan of care.

B) Discuss and describe Endometrial Cancer

Unformatted Attachment Preview

Name: F.K eMedley Log SUBJECTIVE CC: SOAP NOTE Date: 06/16/2017 Age: 25 years Time: 9:02 Sex: Female “I had a positive urine pregnancy test at home and I came to seek care for my pregnancy" HPI: F.K. is a 25 years old Hispanic female who presents to the GYN office today to seek prenatal care after having a positive urine pregnancy test at home last week. Patient is calm, comfortable, and appears to be in no acute distress. Patient reports missing menstrual period for 6 weeks and mild morning nausea and breast tenderness for the last 3 weeks. Patient states she feels nauseated in the mornings after breakfast but nausea goes away by itself. Patient denies vomiting, vaginal discharge, bleeding or any other symptoms. Patient reports trying to conceive for the last 6 months after stopping oral contraceptives. Patient is G1P0 based on results of home pregnancy test. Patient reports LMP 05/03/2017 and decides to do a pregnancy test last week after missing her period for about 5 weeks. Patient reports regular menstrual periods every 28 days lasting 4 to 5 days and using 3 to 4 tampons a day. Patient is sexually active and in a monogamous relationship with her husband. Reports 2 lifetime sexual partner and denies sexually transmitted diseases (STDs). Patient she is taking folic acid 400 mcg daily and multivitamins. Patient provided the HPI as follows: O – Onset of symptoms – Missing periods 6 weeks, nausea and breast tenderness 3 weeks. L – Location of symptom – Uterus, digestive system, and breasts D – Duration of symptom – Missing menstrual period constant for 6 weeks. Nausea intermittent, in the morning for 3 weeks. Breast tenderness constant for 3 weeks. C – Character of symptom – Breast are sensitive and feel swell. Nausea is mild occur after breakfast. A – Aggravating/Alleviating Factors – Breast tenderness get worse whit touch and alleviate when wearing a support bra. R – Radiation of symptom (if pain) –None. T – Timing of symptom – Nausea in the morning after breakfast. Missing periods and breast tenderness are unchanged through the day and night. T – Treatment received so far – None S – Severity of symptom - Nausea and breast tenderness are mild. Patient relates those symptoms with the missing period as signs of pregnancy. Prenatal care is important for a healthy pregnancy to ensure maternal safety and to allow early fetal assessment. Prenatal care should follow a holistic approach taking in consideration the physical, social, and emotional needs of the pregnant woman (Schuiling& Likis, 2017). Prenatal care includes prenatal visits, nutritional care, and education and patient patient-specific issues. The first prenatal visit should include a comprehensive health history and physical examination, laboratory work including Pap smear and sexually transmitted disease (STD) testing, and education about pregnancy health (Schuiling& Likis, 2017). The Institute of Medicine (IOM) recommended guidelines to determine the expected weight gain during pregnancy based on the body mass index (BMI) (IOM, 2009). Nutrition education should promote a wellbalanced and varied diet following patient's food preferences with an increase of 350 to 450 calories per day and including protein, carbohydrates, fats, and micronutrients (IOM, 2009). Daily prenatal vitamins containing folic acid 400 micrograms and vitamins A, C, D, E, B6, B12, niacin, thiamin, riboflavin, calcium, zinc, iodine, and iron are recommended as tolerated throughout pregnancy (IOM, 2009). The American Academy Pediatrics (AAP), American Congress of Obstetricians and Gynecologists (ACOG), and the March of Dimes recommend that prenatal care visits scheduled at proper intervals for testing and screenings, monitoring normal pregnancy, and potential complications (AOCG, 2012).The AOCG recommends screening for depression and psychosocial screening for all pregnant woman not only during the first visit but during prenatal care to recognize patients at risk and initiated treatment and appropriate referrals (ACOG, 2015; ACOG, 2006). The ACOG also recommends influenza vaccine for pregnant woman during the influenza season and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during the third trimester (ACOG, 2013). During the first prenatal visit education should be provided healthy behaviors, dental care, nutrition, wearing a seat belt, exercise, avoiding substance and hazardous-chemical exposure and hot tubs or saunas, domestic violence exposure, sexual activity, avoidance of alcohol, tobacco and recreational drugs among others (Schuiling& Likis, 2017). Based on the above recommendations, the patient was given a complete physical exam including a pelvic and a breast exam, a Pap smear, screening for STDs including Chlamydia and Gonorrhea, and education and counseling about nutritional needs during pregnancy, vaccines, prenatal care and promotion of healthy behaviors during pregnancy. Medications: (list with reason for med ) Folic acid 400 mcg one tablet orally in the morning as a supplement Multivitamins one tablet orally daily as a supplement. PMH Allergies: No known drug, food, latex, or environmental allergies Medication Intolerances: None Chronic Illnesses/Major traumas: Denies any chronic illness or trauma. Hospitalizations/Surgeries: Denies any hospitalization or surgery Immunizations: Admits receiving recommended vaccines and having immunization records uptoday Family History (at least 3 generations) Mother: 50 years old and healthy Father: 50 years old with hypertension Maternal GM 81 years old with diabetes Maternal GF Deceased at age 70 leukemia Paternal GM: 75 years old with hypertension Paternal GF: 77 years old with hypertension and high cholesterol Brother: 29 years old healthy Social History Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, marijuana. Safety status Education Level: Bachelors degree in Education. Occupational history: Elementary school teacher. Works full-time Monday to Friday 40 hours a week. Currently on vacation. She is a 10 months employee and school year ended last week. She will return to work in the second or third week of August. Current living situation: Married. Lives with husband in a rented apartment. Substance use/abuse: Denies substance use/abuse. ETOH: Denies use. Tobacco Use: Non- smoker Safety Status: States she always uses seat belt while driving and as a passenger. Home environment is safe and free from physical hazards and emotional abuse. ROS General Cardiovascular Patient denies fatigue, fever, chills. Denies weight change and night sweats. Denies lack of appetite. Denies chest pain, palpitations, PND, orthopnea, and edema. Skin Respiratory Denies delayed healing, rashes, bruising, bleeding or skin discolorations, any changes in lesions or moles. Denies cough, wheezing, hemoptysis, dyspnea, pneumonia history, and TB history and contacts. Eyes Gastrointestinal Denies use of corrective lenses. Denies blurring, and visual changes of any kind Patient reports morning nausea after breakfast that goes away by itself for 3 weeks. Patient denies vomiting, abdominal pain, diarrhea, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, black tarry stools. Ears Genitourinary/Gynecological Patient denies ear pain, hearing loss, ringing in ears, discharge. Denies any urgency, frequency, or change in color of urine. Sexually active at age 19. Two lifetime sexual partners. Denies STDs or condom use. Us Fe: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx Last Pap: Pap smear 2015 Breast Self-Exam (BSE): Admits to performing monthly BSE after menses. Mammogram: Denies Menstrual complaints: Missing menstrual period for 6 weeks. o o Menarche: 13 years old Frequency of menstrual periods: Every 28 days. o Length: 4-5 days. o Menstrual flow: 3-4 tampons a day. o Dysmenorrhea: Denies o LPM: 05/03/2017 Vaginal discharge: Denies Pregnancy history: G1P0. Based on results of home urine pregnancy test. Nose/Mouth/Throat Musculoskeletal Denies sinus problems, dysphagia, nose bleeds/discharge, dental disease, hoarseness, or throat pain Breast Denies back pain, joint swelling, stiffness or pain, fracture history, osteoporosis. Patient reports breast tenderness and swelling for 3 weeks. Denies lumps, or bumps. Admits BSE. Denies syncope, seizures, transient paralysis, weakness, paresthesias, black out spells. Heme/Lymph/Endo Psychiatric Denies HIV status. Denies blood transfusion history. Denies bruising, night sweats, swollen glands, increase thirst, increase hunger, cold or heat Denies anxiety, sleeping difficulties, suicidal ideation/attempts, previous dx. Neurological intolerance. OBJECTIVE (Document in the Inspection, Palpation, Percussion, Auscultation) format except on Abdomen (IAPP) Weight: 121lbs BMI: 21.4 Temp: 98.8 F BP: 112/69mmHg Height: 5ft 3 inches Pulse: 68 beats/min Respirations: 16 breaths/min General Appearance: Patient F.K. is a healthy-appearing 25 years old Hispanic female in no acute distress. She is well developed and well nourished. She is alert and oriented x 4, answers questions appropriately; cooperative during interview. She is dressed in clean blue pants and a white top. Skin Patient’s skin is pale pink and appropriate to her Hispanic ethnicity, warm, dry, clean and intact. No rashes or lesions noted. HEENT Head is normocephalic, atraumatic and without lesions; hair evenly distributed. No tenderness at facial and maxillary sinuses. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly grey with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; congested and boggy. No septal deviation. Neck: Supple. Full ROM; cervical lymphadenopathy present and palpable; no occipital nodes. No thyromegaly or nodules. Oral mucosa pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair. Cardiovascular S1, S2 with regular rate and rhythm. No extra heart sounds, clicks, rubs or murmurs. Capillary refill less than 2 seconds. Pulses 3+ throughout. No edema. Respiratory Symmetric chest wall. Respirations regular and easy; lungs sounds present and clear to auscultation in all fields bilaterally. No anterior or posterior crackles/wheezes. Gastrointestinal Abdomen appears flat and non-distended; BS active in all 4 quadrants per auscultation. No rebound tenderness noted with percussion. Abdomen soft and non-tender to gentle palpation. No hepatosplenomegaly. Breast Breasts are free from masses, tender to light touch, no discharge, no dimpling, wrinkling or discoloration of the skin. Genitourinary Female:Bladder is non-distended; no CVA tenderness. External genitalia reveal coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A medium size speculum was inserted; vaginal walls are dark pink and well rugated; with thin vaginal discharge, no lesions noted. Cervix soft, has smooth surface, dark pink with nulliparous cervical os. No lesions or drainage observed. Pap obtained and swabs for cultures. Bimanual examination: Cervix is soft, No CMT. Uterus is antevert, slightly increased in size and regular shape, non tender. Bladder is not distended. No adnexal masses or tenderness. Ovaries are non-palpable. Musculoskeletal Full ROM seen in all 4 extremities as patient moved about the exam room. Neurological Speech clear. Good tone. Posture erect. Balance stable. Gait normal. Psychiatric Alert and oriented. Dressed in clean blue pants and a white top. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately. Denies depression or anxiety. Lab Tests Dipstick urinalysis: Normal results Whiff test: Negative for amines Urine pregnancy test: Positive Pending results for the following tests: Complete blood count (CBC) Blood type and Rh factor Antibody screen Rubella titer Hepatitis B surface antigen (HBsAg) Varicella antibody screen HIV testing Syphilis testing using Venereal Disease Research Laboratory (VDRL) Urinalysis and urine Culture Chlamydia and gonorrhea testing Pap smear Special Tests None Diagnosis Differential Diagnoses o Leiomyoma of uterus unspecified (d25.9). Uterine fibroids are abnormal growths of smooth muscle in the uterus most frequent in women older than 30. Fibroids usually do not cause symptoms or may present with pelvic pain or vaginal bleeding. Physical examinations evidenced a firm and enlarged uterus with irregular shape (Cash & Glass, 2014). A uterine fibroid was suspected in this patient due to the enlarged uterus but is being ruled out based on the health history and physical examination. o Unspecified ectopic pregnancy (O.009). Ectopic pregnancy occurs when a fertilized egg implanted outside the uterus, can be life-threatening for the mother if not diagnosed and treated early, and is diagnosed during the first trimester of pregnancy (Schuiling& Likis, 2017). The diagnosis was suspected in this patient based on her history of missing menstrual period associated with breast tenderness and nausea and a positive pregnancy test but is being ruled out because patient doesn’t report any pelvic pain and the physical examination doesn’t evidenced the presence of a mass or tenderness in the adnexas which are the most frequent site for implantation. o Hydatidiform mole, unspecified (O01.9). Hydatidiform mole is another differential diagnosis and was suspected based on the history of missed menses and presumptive signs of pregnancy but patients with molar also complaint of abdominal pain, vaginal bleeding, severe nausea and vomiting, tachycardia and hypertension (Schuiling& Likis, 2017). Based on the health history and physical examination this diagnosis is ruled out. Diagnosis o Encounter for supervision of normal first pregnancy, first trimester (Z34.01). Pregnancy is suspected in any woman with amenorrhea. The diagnosis of pregnancy is based on data from health history, physical examination, and laboratory work evidencing elevated levels of human chorionic gonadotropin (hCG) hormone (Schuiling& Likis, 2017). Changes in the breasts, fatigue, urinary frequency, and nausea and vomiting are common symptoms reported by woman in addition to amenorrhea and are known as presumptive signs of pregnancy (Schuiling& Likis, 2017). During physical examination will evidence softening of the cervix and uterus, bluish discoloration of the vagina and cervix and enlarged uterus which are known as probable signs of pregnancy (Schuiling& Likis, 2017). Lastly, positive signs of pregnancy are auscultation of the fetal heart rate and visualization by ultrasound (Schuiling& Likis, 2017). This patient present with history of missing menses for 6 weeks, complaints of morning nausea and breast tenderness, and a positive urine pregnancy test and her physical examination evidenced a softened cervix and enlarged uterus with regular shape. Based on the heath history, physical examination, and lab we can establish the diagnosis of pregnancy. o Less than 8 weeks gestation of pregnancy (Z3A.01). Based on patient LMP 05/03/2017 the gestational age for this patient is 6 weeks and 2 days and her estimated date of birth (EDB) using the using Nägle’s rule is 02/10/2018 (Schuiling& Likis, 2017). Plan/Therapeutics o Plan: ▪ ▪ Further testing - None. The goals of prenatal care are to improve pregnancy outcomes and prevent complications during pregnancy (Schuiling& Likis, 2017). ▪ ▪ Medication: a. Prenatal vitamins: Take one tablet orally daily with meals. Prenatal vitamins containing 400 mcg of folic acid and daily allowance of vitamins are recommended to prevent neural tube defects and normal development of the fetus (Schuiling& Likis, 2017). Education: a. Priorities for the first-visit teaching include ensuring the woman has adequate resources, include general information on topics such as nutrition, healthy behaviors, dental care, exercise, wearing a seat belt, avoiding substance and hazardous-chemical exposure, hot tubs or saunas, potential domestic violence exposure, and sexuality during pregnancy (Schuiling& Likis, 2017). b. Pregnancy requires an increase of 350 to 450 calories per day and a well-balanced, varied, nutritional diet consistent with the patient's food preferences should be encourage consisting of three meals per day and at least two snacks (IOM, 2009) c. The meal plan should include protein, carbohydrates, fats, and micronutrients and is individualized to the health, weight (BMI), and all factors that can affect the pregnant woman and fetus. A diet rich in folic acid, omega-3-rich fish or supplement, fruits, and vegetables, fiber-rich carbohydrates, low-fat meat protein or vegetable-based protein, monounsaturated fats, and micronutrients via food should be encouraged (IOM, 2009) d. Weight gain during pregnancy is based on the BMI. You have a BMI of 21.4 which is considered normal and should expect a weight gain of 25 to 35 pounds throughout the pregnancy (IOM, 2009) e. Prenatal vitamin supplements containing recommended daily allowances of folic acid and vitamins A, C, D, E, B6, B12, niacin, thiamin, riboflavin, calcium, zinc, iodine, and iron are recommended (IOM, 2009) f. Encourage to avoid unpasteurized milk, soft cheeses, raw or undercooked meat, poultry, and shellfish, prepackaged lunch meat, hot dogs, meat spreads, raw or partially cooked eggs, unpasteurized juices, unwashed fruits and vegetables, and raw alfalfa sprouts to reduce the risk for infections that can harm both the pregnant woman and the fetus (Schuiling& Likis, 2017). g. Caffeine intake should be limited to 200 mg daily maximum or two cups of coffee of 8 oz each (Schuiling& Likis, 2017). Alcohol consumption is contraindicated in pregnancy (Schuiling& Likis, 2017). i. Vaccines are recommended during pregnancy: Influenza vaccine should be received during influenza season and Tdap vaccine during the third trimester between 27 to 36 weeks (AOCG, 2013) j. Pregnancy-related discomforts are caused by the physiologic changes of pregnancy such as nausea and vomiting, fatigue, breast tenderness, constipation, and nasal stuffiness and congestion (Schuiling& Likis, 2017). k. To decrease or avoid nausea and vomiting eat five to six small meals throughout the day and avoid spicy or hot foods (Schuiling& Likis, 2017). l. Fatigue is common pregnancy discomfort, frequent during the first trimester, improve during the second and often return at the end of pregnancy. To prevent or decrease fatigue balance activity and rest period thorough the day (Schuiling& Likis, 2017). m. Breast tenderness is a common during pregnancy caused by increased levels of hormones preparing breast for lactation, wearing a properly fitted, supportive bra would help relieve the discomfort (Schuiling& Likis, 2017). n. Constipation is common during pregnancy. Increase dietary fiber and fluids or using bulk forming laxatives will help alleviating constipation during pregnancy (Schuiling& Likis, 2017). o. Nasal stuffiness and congestion can be treated with saline nose drops or saline nasal spray and placing a humidifier in the bedroom at night to add moisture to the air (Schuiling& Likis, 2017). Non-medication treatments: a. Benefits of breastfeeding, recommended as the best feeding method for most infants (Zolotor & Carlough, 2014). b. Air travel is generally safe for woman with uncomplicated pregnancies until 36 weeks of gestation. Long trips either a flight or by car increase the risk for deep vein thrombosis (DVT). To prevent DVT wear compression stockings, move your legs frequently, and drink plenty of fluids during your trip (Zolotor & Carlough, 2014). c. Practice good oral hygiene and visit the dentist for prophylaxis and dental care (Zolotor & Carlough, 2014). d. Exercise is recommended during pregnancy. Engage in at least 30 minutes of moderate exercise on most days of the week. Avoid contact sports, activities with risk of abdominal trauma, and scuba diving e. Avoid hair dyes and treatments during early pregnancy (Zolotor & Carlough, 2014). f. Avoid exposure to heavy metals during early pregnancy as they may affect the fetus neurological development (Zolotor & Carlough, 2014). g. Avoid herbal therapies with known harmful effects to the fetus, such as ginkgo, ephedra, and ginseng, do not take over the counter (OTC) medications or herbal products without consulting with your health care provider (Zolotor & Carlough, 2014). h. Avoid hot tubs and saunas during the first trimester, they are associated with neural tube defects and miscarriage (Zolotor & Carlough, 2014). i. Avoid ionizing radiation, because it may affect fetal thyroid development. No harmful effects have been found on the use of use of h. ▪ microwaves, computers, or cell phones (Zolotor & Carlough, 2014). Wear a three point seat bell at all times as a driver or passenger (Zolotor & Carlough, 2014). k. Continue sexual activity unless is restricted by your health care provider related with conditions such as preterm labor and placenta previa amount others (Zolotor & Carlough, 2014). l. Avoid exposure to solvents, particularly in areas without adequate ventilation (Zolotor & Carlough, 2014). m. Most women can continue working during pregnancy but prolonged standing and exposure to certain chemicals are not recommended and are associated with pregnancy complications (Zolotor & Carlough, 2014). n. Alcohol, tobacco products and recreational drugs are to be avoided during pregnancy (Zolotor & Carlough, 2014). o. Practice good hygiene measures: wipe yourself from front to back with every urination and bowel movement to prevent urinary tract infections, avoid perfumed hygiene sprays, talcs, and harsh soaps, wear cotton underwear and sleep without underwear (Cash & Glass, 2014). p. Encourage attendance to childbirth education classes (Zolotor & Carlough, 2014). Follow-up: a. Prenatal care visits should be scheduled throughout the pregnancy to monitor the pregnant woman and the fetus, ensure timely testing and screenings, and monitoring for complications (AOCG. 2012) b. Follow visits for an uncomplicated pregnancy are scheduled every 4 weeks until week 28, every 2 to 3 weeks between weeks 28 to 36 and weekly after week 36 and include evaluation of BP, weight, edema, urine testing, fetal heart rate, fundal height starting at 20 weeks, and Leopold maneuvers starting at 36 weeks. Psychosocial screening should be completed at least once each trimester to identify potential problems (AOCG, 2012) c. Contact your health care provider if you have abdominal pain, vaginal bleeding, fever 100.4 or above, rapid heartbeats, or any other abnormal symptom (AOCG, 2012). j. ▪ Evaluation of patient encounter: This week I have reviewed the diagnosis of pregnancy, prenatal care and nutritional needs during pregnancy with my preceptor based on the guidelines from the ACOG and IMO. This patient encounter gave me the opportunity to apply the knowledge acquired this week through the readings and interaction with my preceptor and I had the opportunity to evaluate this patient on her first pregnancy and educated and counseled her about healthy behaviors, how to alleviate discomfort of pregnancy, and nutrition during pregnancy. With the guidance of my preceptor I developed the plan of care including medications, education and non medications treatment for this patient during her first prenatal visit. I consider, the knowledge I have acquired this week is strong and prepares me for my future role as Nurse Practitioner. References American Academy Pediatrics, American Congress of Obstetricians and Gynecologists, & March of Dimes. (2012). Guidelines for perinatal care (7th ed.). Retrieved from http://www.acog.org/Search?Keyword=guidelines+for+perinatal+care American Congress of Obstetrics and Gynecology (2013). Committee Opinion No. 566: Update on immunization and pregnancy: Tetanus, Diphtheria, and Pertussis vaccination. Retrieved from https://www.acog.org/Resources-And-Publications/CommitteeOpinions/Committee-on-Obstetric-Practice/Update-on-Immunization-and-PregnancyTetanus-Diphtheria-and-Pertussis-Vaccination American Congress of Obstetrics and Gynecology (2015). ACOG Committee Opinion No. 630: Screening for perinatal depression. Retrieved from https://www.acog.org/ResourcesAnd-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-forPerinatal-Depression Cash, J., & Glass, C. (2014). Family practice guidelines (3rd ed.). [VitalSource Bookshelf Online]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780826168757/cfi/172!/4/4@0.00:56.6 Schuiling, K., & Likis, F. (2017). Women’s gynecologic health (3rd ed.). [VitalSource Bookshelf Online]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781284124637 Zolotor, A., & Carlough, M. (2014). Update on prenatal care. American Family Physician, 89(3), 199-208. retrieved from http://www.aafp.org/afp/2014/0201/p199.html
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Endometrial Carcinoma
This cancer is characterized by obvious anaplasia and hyperplasia of the glandular elements as
well as invasion of underlying myometrium, stroma or vascular space. It can spread by four
possible routes: lymphatic metastases, hematogenous spread, direct extension and peritoneal
implants after transtubal spread
There are three histologic types of endometrial carcinoma: adenocarcinoma, adenocarcinoma
with squamous differentiation, and adenosquamous carcinoma.
Clinical features
The most common symptom is postmenopausal bleedin...


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