A 65-year-old obese postmenopausal woman with type 2 diabetes presents with postmenopausal bleeding. Endometrial biopsy shows grade 1 endometrioid adenocarcinoma. Imaging confirms disease confined to the endometrium. For a medically operable patient, the standard surgical approach is:

• A Total abdominal hysterectomy alone (no node dissection)
• B Vaginal hysterectomy alone (minimises surgical risk)
• C Extended radical hysterectomy with parametrial resection
• D Total laparoscopic/robotic hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node mapping ✓

Explanation

The standard surgical treatment for endometrial carcinoma is total hysterectomy (minimally invasive preferred — laparoscopic or robotic) with bilateral salpingo-oophorectomy. Sentinel lymph node mapping has replaced routine full lymphadenectomy in early-stage disease as it achieves equivalent staging with lower morbidity; the FIRES trial validated its accuracy. Vaginal hysterectomy alone does not allow staging. Radical hysterectomy is not indicated for endometrial cancer.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.