In a remarkable display of multidisciplinary expertise, Aster RV Hospital successfully managed a highly complex case involving a 56-year-old morbidly obese, postmenopausal woman diagnosed with endometrial cancer. The patient, weighing 141.6 kg, had been suffering from recurrent heavy vaginal bleeding for nearly a year, a condition that had severely impacted her quality of life.

The woman, with a known history of hypertension and prediabetes, reported experiencing bleeding every two months lasting up to twelve days, often accompanied by pain and clot passage. Her mobility was significantly restricted due to her obesity, complicating both diagnosis and treatment planning.

An MRI scan in 2024 initially revealed an endometrial polyp protruding through the cervical os. Subsequent endometrial curettage and histopathological examination confirmed moderately differentiated endometrioid carcinoma. Immunohistochemistry further showed estrogen and progesterone receptor positivity, wild-type p53, and loss of MLH1 and PMS2, raising suspicion of Lynch syndrome — a hereditary cancer predisposition condition.

A PET scan later detected increased FDG uptake in the uterus and suspected right pelvic nodal metastasis, along with indeterminate lung nodules, suggesting possible cancer spread.

Under the care of Dr. Smrithi D Nayak, Consultant – Obstetrics & Gynecology, the patient underwent dilation and curettage followed by a laparoscopic radical hysterectomy with peritonectomy and omentectomy on May 22, 2025. Intraoperative findings revealed an enlarged uterus, a left ovarian cyst, dense adhesions, and retroperitoneal lymphadenopathy.

“The patient tolerated the procedure well, and her postoperative recovery was smooth, except for transient loose stools that were successfully managed during her SICU stay,” said Dr. Nayak.

The final histopathology confirmed FIGO Stage IA, Grade 2 endometrioid carcinoma with 29% myometrial invasion, lymphovascular invasion, and negative surgical margins. Notably, all sampled lymph nodes were free of disease, indicating no spread.

Advantages of a Minimally Invasive Approach

Given the patient’s morbid obesity, performing laparoscopic surgery offered several benefits — including reduced surgical morbidity, enhanced intraoperative visualization, faster recovery, and a shorter hospital stay compared to conventional open surgery.

To ensure comprehensive care, the patient also underwent screening for sleep apnea — a condition commonly associated with obesity — as part of her postoperative evaluation.

The loss of MLH1/PMS2 on immunohistochemistry prompted further evaluation for Lynch syndrome, emphasizing the need for genetic counselling and molecular testing in endometrial cancer cases. This step is crucial for identifying inherited cancer risks and guiding future preventive strategies for both patients and their families.

“The case underscores the importance of individualized and multidisciplinary management in treating endometrial cancer among patients with complex health profiles,” added Dr. Smrithi D Nayak. “By combining early diagnosis, precision-based surgical techniques, and genetic evaluation, we can significantly improve outcomes and ensure long-term follow-up tailored to each patient’s unique needs.”

The patient was discharged in stable condition, advised for ongoing surveillance and preventive health measures, marking a successful outcome in one of the most challenging scenarios of gynecologic oncology.