Diagnostic and Management Challenges of Endometrial Tumours in Developing Countries!

Abstract

Gynaecological cancers are among the most common cancers in women and hence an important public health issue in very country. Ovarian, Cervical, and Endometrial cancers contribute the most of Gynaecological cancers in India and worldwide. Endometrial benign tumours like Endometrioid cystadenoma/adenofibroma with endometrioid type glands, associated with endometriosis pose challenges of diagnosis. Endometrial cancer (EC) is the most common gynaecological malignancy in the West, but in India, the incidence rates are low. National cancer registry project (NCRP) estimated 27,922 cases of EC in 2022 in India. The possible association between cancer and endometriosis varies according to the histologic subtype of ovarian cancer and is focused mostly on endometroid and clear-cell ovarian cancer subtypes. The only way to diagnose womb cancer for sure is to take a sample of the tissue lining the womb (biopsy) and get histopathology report. However, most of the literate and urban women with ECs present at an early stage due to menorrhagia, abdominal pain or abdominal distension and are associated with a good prognosis. But the situation in rural India is one of lack of diagnostic and management facilities in public sector even at most of the district level. Treatment for endometrial cancer usually involves a hysterectomy, and adjuvant radiotherapy and/or chemotherapy. Surgery sometimes may include the removal of uterus and the fallopian tubes and ovaries, called a Hysterectomy with salpingo-oophorectomy. Adjuvant Radio/Chemotherapy treatment is planned based on final surgical & pathological staging. Due to the lack of cancer awareness, variable pathology, and dearth of proper screening facilities in most developing countries including India, most rural women report at advanced stages, adversely affecting the prognosis and clinical outcomes.