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Gynaecology > 1: Menstruation: Endometrial Hyperplasia and Endometrial Cancer > Flashcards

1: Menstruation: Endometrial Hyperplasia and Endometrial Cancer Flashcards

1
Q

Define endometrial hyperplasia

A

Abnormal proliferation of the endometrium, more than would expect during menstrual cycle

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2
Q

What is the major risk with endometrial proliferation

A

Risk of endometrial cancer

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3
Q

How have WHO classified endometrial hyperplasia

A
  • Hyperplasia without atypia

- Atypical hyperplasia

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4
Q

What causes endometrial hyperplasia

A

Unopposed oestrogen

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5
Q

How may endometrial hyperplasia present

A

Menorrhagia
Intermenstrual bleeding
Post-menopausal bleeding

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6
Q

Explain pathophysiology of endometrial hyperplasia

A

Unopposed oestrogen stimulates proliferation of the glands causing endometrial hyperplasia

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7
Q

What is first line for investigating endometrial hyperplasia

A

Trans-vaginal US

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8
Q

What on trans-vaginal US indicates endometrial hyperplasia

A

> 4mm

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9
Q

What is performed if endometrial thickness on US is >4mm

A

Endometrial sampling

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10
Q

What is third-line for endometrial hyperplasia

A

Hysteroscopy and biopsy

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11
Q

What is the risk of endometrial hyperplasia without atypia progressing to cancer

A

<5% in 20-years

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12
Q

How should endometrial cancer without atypia be managed

A

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
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13
Q

What is an alternative to levonorgestrel intra-uterine system

A

Continuous oral progesterone

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14
Q

How long should individuals with endometrial hyperplasia without atypia be treated

A

5-years

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15
Q

What is the risk that patients with atypical hyperplasia have endometrial cancer

A

40%

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16
Q

What is the risk of patients with atypical hyperplasia developing endometrial cancer

A

70%

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17
Q

how is atypical hyperplasia managed

A

hysterectomy

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18
Q

why are those with atypical hyperplasia managed with hysterectomy

A

due to risk of progression to endometrial cancer

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19
Q

in post-menopausal women with atypical hyperplasia what is offered

A

hysterectomy with bilateral salpingoopherectomy

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20
Q

what is main complication of endometrial hyperplasia

A

endometrial cancer

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21
Q

what is endometrial cancer

A

adenocarcinoma

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22
Q

what is the prevalence of endometrial cancer in the UK

A

4th most common cancer

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23
Q

what is happening to incidence of endometrial cancer and why

A

increasing - thought due to obesity

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24
Q

when is peak incidence of endometrial cancer

A

65-75y

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25
Q

in which population does endometrial cancer occur

A

post-menopausal women

26
Q

in which ethnicity is endometrial cancer more common

A

North American

27
Q

what causes endometrial cancer

A

Unopposed oestrogen exposure

28
Q

what are 3 groups of risk factors that lead to increase oestrogen

A
  1. Anovulation
  2. Unopposed oestrogen
  3. Other
29
Q

why does anovulation increase risk oestrogen

A

Due to no production of corpus luteum which is meant to release progesterone

30
Q

what anovulatory factors increase risk of endometrial cancer

A
  • PCOS
  • Early menarche
  • Late menopause
  • Nulliparous
31
Q

what are two protective factors against endometrial cancer

A
  • Multiparous

- COCP

32
Q

what are 3 causes of oestrogen exposure

A
  • HRT
  • Tamoxifen
  • Obesity
33
Q

why does obesity increase oestrogen

A

Increases peripheral conversion androgens to oestrogen

34
Q

what ‘other’ factors increase risk of endometrial cancer

A

Age, Lynch Syndrome

35
Q

what syndrome is endometrial cancer associated with

A

Lynch Syndrome

36
Q

what are two protective factors for endometrial cancer

A

COCP

Multiparous

37
Q

what is the main symptom of endometrial cancer

A

post-menopausal bleeding

38
Q

what % of women with endometrial cancer will have PMB

A

90

39
Q

what % women with PMB will have endometrial cancer

A

10 - very non-specific sign

40
Q

what are 2 other symptoms of endometrial cancer

A

Clear vaginal discharge
Weight loss
Abdominal pain

41
Q

What are the vulval causes of post-menopausal bleeding

A

Atrophic vaginitis

Vulval carcinoma

42
Q

What are the cervical causes of postmenopausal bleeding

A

Cervical polyps

Cervical cancer

43
Q

What are the endometrial causes of PMB

A

Endometrial cancer

Endometrial polyps

44
Q

what is first-line for endometrial cancer

A

Transvaginal-US

45
Q

what endometrial thickness is abnormal

A

> 4

46
Q

if endometrial thickness is more than 4 what should be done

A

Pipelle biopsy

47
Q

what type of biopsy is used for endometrial cancer

A

Pipelle biopsy

48
Q

if patient is high-risk, what type of biopsy will they recieve

A

Hysteroscopy and biopsy

49
Q

what is used to stage endometrial cancer

A

FIGO (Federation international obstetrics and gynaecology)

50
Q

what staging system is used for endometrial cancer

A

FIGO

51
Q

what is FIGO stage 1

A

Uterus only

52
Q

what is FIGO stage 2

A

Uterus and cervix

53
Q

what is FIGO stage 3

A

Pelvis

54
Q

what is FIGO stage 4

A

Outside pelvis

55
Q

How is FIGO stage 1 cancer managed

A
  • Hysterectomy and bilateral salping-oopherectomy
56
Q

What should be taken during hysterectomy and bilateral salpinoopherectomy

A
  • Peritoneal washings
57
Q

What is 5-year survival rate of type 1 endometrial cancer

A

90

58
Q

What is management for FIGO stage 2 cancer

A

Radical hysterectomy and lymphadenectomy

59
Q

How is stage 3 FIGO managed

A

De-bulking surgery

Chemoradiotherapy

60
Q

How is stage 4 FIGO managed

A

De-bulking surgery
Palliative radiotherapy
High-dose oral progesterone

Frail old ladies who cannot undergo surgery are given oral progesterone

61
Q

What is 5-year survival in FIGO stage-4 cancers

A

25%

Gynaecology (22 decks)

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