1: Menstruation: Endometrial Hyperplasia and Endometrial Cancer Flashcards
Define endometrial hyperplasia
Abnormal proliferation of the endometrium, more than would expect during menstrual cycle
What is the major risk with endometrial proliferation
Risk of endometrial cancer
How have WHO classified endometrial hyperplasia
- Hyperplasia without atypia
- Atypical hyperplasia
What causes endometrial hyperplasia
Unopposed oestrogen
How may endometrial hyperplasia present
Menorrhagia
Intermenstrual bleeding
Post-menopausal bleeding
Explain pathophysiology of endometrial hyperplasia
Unopposed oestrogen stimulates proliferation of the glands causing endometrial hyperplasia
What is first line for investigating endometrial hyperplasia
Trans-vaginal US
What on trans-vaginal US indicates endometrial hyperplasia
> 4mm
What is performed if endometrial thickness on US is >4mm
Endometrial sampling
What is third-line for endometrial hyperplasia
Hysteroscopy and biopsy
What is the risk of endometrial hyperplasia without atypia progressing to cancer
<5% in 20-years
How should endometrial cancer without atypia be managed
Lifestyle: Weight Loss, Stop HRT
Medical:
- LNG-IUS or POP
- Repeat endometrial biopsy at 6-months
Lifestyle factors: weight loss, stop HRT
- 6m endometrial biopsy
- Levornegestrel releasing system
What is an alternative to levonorgestrel intra-uterine system
Continuous oral progesterone
How long should individuals with endometrial hyperplasia without atypia be treated
5-years
What is the risk that patients with atypical hyperplasia have endometrial cancer
40%
What is the risk of patients with atypical hyperplasia developing endometrial cancer
70%
how is atypical hyperplasia managed
hysterectomy
why are those with atypical hyperplasia managed with hysterectomy
due to risk of progression to endometrial cancer
in post-menopausal women with atypical hyperplasia what is offered
hysterectomy with bilateral salpingoopherectomy
what is main complication of endometrial hyperplasia
endometrial cancer
what is endometrial cancer
adenocarcinoma
what is the prevalence of endometrial cancer in the UK
4th most common cancer
what is happening to incidence of endometrial cancer and why
increasing - thought due to obesity
when is peak incidence of endometrial cancer
65-75y
in which population does endometrial cancer occur
post-menopausal women
in which ethnicity is endometrial cancer more common
North American
what causes endometrial cancer
Unopposed oestrogen exposure
what are 3 groups of risk factors that lead to increase oestrogen
- Anovulation
- Unopposed oestrogen
- Other
why does anovulation increase risk oestrogen
Due to no production of corpus luteum which is meant to release progesterone
what anovulatory factors increase risk of endometrial cancer
- PCOS
- Early menarche
- Late menopause
- Nulliparous
what are two protective factors against endometrial cancer
- Multiparous
- COCP
what are 3 causes of oestrogen exposure
- HRT
- Tamoxifen
- Obesity
why does obesity increase oestrogen
Increases peripheral conversion androgens to oestrogen
what ‘other’ factors increase risk of endometrial cancer
Age, Lynch Syndrome
what syndrome is endometrial cancer associated with
Lynch Syndrome
what are two protective factors for endometrial cancer
COCP
Multiparous
what is the main symptom of endometrial cancer
post-menopausal bleeding
what % of women with endometrial cancer will have PMB
90
what % women with PMB will have endometrial cancer
10 - very non-specific sign
what are 2 other symptoms of endometrial cancer
Clear vaginal discharge
Weight loss
Abdominal pain
What are the vulval causes of post-menopausal bleeding
Atrophic vaginitis
Vulval carcinoma
What are the cervical causes of postmenopausal bleeding
Cervical polyps
Cervical cancer
What are the endometrial causes of PMB
Endometrial cancer
Endometrial polyps
what is first-line for endometrial cancer
Transvaginal-US
what endometrial thickness is abnormal
> 4
if endometrial thickness is more than 4 what should be done
Pipelle biopsy
what type of biopsy is used for endometrial cancer
Pipelle biopsy
if patient is high-risk, what type of biopsy will they recieve
Hysteroscopy and biopsy
what is used to stage endometrial cancer
FIGO (Federation international obstetrics and gynaecology)
what staging system is used for endometrial cancer
FIGO
what is FIGO stage 1
Uterus only
what is FIGO stage 2
Uterus and cervix
what is FIGO stage 3
Pelvis
what is FIGO stage 4
Outside pelvis
How is FIGO stage 1 cancer managed
- Hysterectomy and bilateral salping-oopherectomy
What should be taken during hysterectomy and bilateral salpinoopherectomy
- Peritoneal washings
What is 5-year survival rate of type 1 endometrial cancer
90
What is management for FIGO stage 2 cancer
Radical hysterectomy and lymphadenectomy
How is stage 3 FIGO managed
De-bulking surgery
Chemoradiotherapy
How is stage 4 FIGO managed
De-bulking surgery
Palliative radiotherapy
High-dose oral progesterone
Frail old ladies who cannot undergo surgery are given oral progesterone
What is 5-year survival in FIGO stage-4 cancers
25%
