Which of the following direct lymph node dissections in endometrial carcinoma:a) Penetration into half of myometriumb) Clear cell Carcinomac) Fundal involvement d) Peritoneal metastasise) Papillary serous carcinoma

Indications for lymph node (pelvic and Para-aortic) dissection in endometrial cancer Tumor histology: Clear cell carcinoma Papillary serous carcinoma Squamous carcinoma Adenocarcinoma (endometriod) grade II and Ill. More than half of myometrial invasion Isthmus- cervix extension Extrauterine disease Note: In absence of this factor only bilateral pelvic lymphadenectomy is performed if the tumor size is greater than 2 cms. Para-aortic lymphadenectomy would be performed if pelvic lymph nodes are positive. Lymphadenectomy is altogether omitted for a patient with above risk factors absent, the absence of cervical involvement and tumor size less than 2 cms. As far as Peritoneal metastasis is concerned: "Positive peritoneal cytology in itself is not a marker of poor prognosis, i.e. is not an indication for lymph node dissection unless and until associated with other poor prognostic markers as above."   ... Novak 14th /ed p 1358