Erken Evre Endometrium Kanserli Hastalarda Primer Cerrahi Sonrası Optimal Takip Protokolü Belirlenmesi

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Thesis Type: Expertise In Medicine

Institution Of The Thesis: Ankara University, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Turkey

Approval Date: 2018

Thesis Language: Turkish

Student: CAN OZAN ULUSOY

Supervisor: SALİH TAŞKIN

Open Archive Collection: AVESIS Open Access Collection

Abstract:

Endometrial carcinoma is the most common gynecologic malignancy. The whole life risk of getting endometrial cancer diagnosis is %2.8. Primary treatment of endometrial carcinoma is surgery but there are also adjuvant treatment options like chemotherapy, radiotherapy and hormonal therapy. Universal consensus is not established about ideal follow up protocol after surgery. The aim of this study is to create a follow up protocol for patients with early stage endometrial cancer and decide which tests are more useful in detecting recurrences. Materials-Methods: 303 patients with stage 1 and 2, grade 1-3 endometrioid type endometrial cancer who underwent follow-up for at least 2 years were included in the study. Recurrence were diagnosed in 17 patients (5,61). Diagnostic method in recurrence was analyzed for each patient. Analysis of risk factors for recurrence were done using SPSS. Specificity sensitivity analyzes were also performed among the diagnostic methods. Results : Risk of recurrence rates when examined cumulatively against time; the first 23 months had a risk of developing 3.06%, the first 33 months had a recurrence rate of 7.52%. Sensitivity of physical examintaion was 50.00%, specificity 99.52%, positive predictive value 88.89%, negative predictive value 96.30% and accuracy rate 96.00% respectively. It was found that each step increase of grade increased recurrence odds by 2.549 times (95% CI : 1,078 – 6,027; p=0,033). and each step increase of stage increased recurrence odds by 2,943 times (95% CI : 1,270 – 6,820; p=0,012). Conclusion: It is noteworthy that recurrence rate increases after 25 months and the risk of recurrence increases as the tumor stage and grade worsens. Especially after the first 2 years symptoms in patients with high grade and deep myometrial invasion should be considered risky and patients should be informed about seeking medical care when symptoms occur. In conclusion, physical examination and symptoms of patients are key factors in detecting reccurences other diagnostic methods can be used according to clinical findings. Keywords : Endometrium cancer, follow up protocol