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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [26] Endometrial Cancer > Flashcards

[26] Endometrial Cancer Flashcards

1
Q

What is endometrial cancer?

A

A cancer arising from the lining of the uterus

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2
Q

How common is endometrial cancer?

A

The 4th most common cancer in women in the UK

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3
Q

How many new cases of endometrial cancer are there each year in the UK?

A

8,600

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4
Q

How many deaths are caused by endometrial cancer each year in the UK?

A

2,300

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5
Q

What is the median age of endometrial cancer?

A

63

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6
Q

What % of women with endometrial cancer are over 50?

A

90%

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7
Q

Where is endometrial cancer more common?

A

Western societies

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8
Q

What is the most common histological type of endometrial cancer?

A

Adenocarcinoma

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9
Q

What % of endometrial cancer is adenocarcinoma?

A

80%

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10
Q

What are the two main types of endometrial cancer?

A
  • Type 1

- Type 2

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11
Q

What is Type 1 endometrial cancer?

A

Oestrogen dependent endometrioid

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12
Q

What is Type 2 endometrial cancer?

A

Oestrogen independent non-endometrioid

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13
Q

What are the risk factors for endometrial cancer?

A
  • Prolonged periods of unopposed oestrogen
  • Nulliparous
  • Menopause past 52
  • Obesity
  • Endometrial hyperplasia
  • PCOS
  • DM
  • Tamoxifen
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14
Q

What is the main risk factor for endometrial cancer?

A

Prolonged unopposed oestrogen

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15
Q

What can cause prolonged periods of unopposed oestrogen?

A
  • Medication

- Anovulatory cycles where corpus luteum does not mature and secrete progesterone

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16
Q

What is endometrial hyperplasia?

A

Excessive proliferation of the cells of the endometrium

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17
Q

Why is endometrial hyperplasia a significant finding?

A

It is a significant risk factor for the development of endometrial cancer

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18
Q

What is essential in women with endometrial hyperplasia?

A

Careful monitoring and treatment

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19
Q

What causes most cases of endometrial hyperplasia?

A

High levels of oestrogen combined with insufficient progesterone

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20
Q

Why is sufficient progesterone important in preventing endometrial cancer and hyperplasia?

A

It normally counteracts the pro-proliferative effects of oestrogen on the tissues

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21
Q

What are the classifications of endometrial hyperplasia?

A
  • Hyperplasia without atypia

- Atypical hyperplasia

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22
Q

Which type of endometrial hyperplasia is considered a pre-malignant condition of the uterus?

A

Atypical hyperplasia

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23
Q

How does endometrial hyperplasia normally present?

A
  • Abnormal vaginal bleeding

- Sometimes vaginal discharge

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24
Q

What types of abnormal vaginal bleeding may occur in endometrial hyperplasia?

A
  • Intermenstrual bleeding
  • Irregular bleeding
  • Menorrhagia
  • Post-menopausal bleeding
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25
Q

How is endometrial hyperplasia definitively diagnosed?

A

Biopsy

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26
Q

How can biopsy to test for endometrial hyperplasia be obtained?

A
  • Outpatient endometrial sampling with pipelle biopsy

- Hysteroscopy and curettage biopsy

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27
Q

When is an endometrial curettage biopsy preferred to pipelle biopsy?

A

When there are polyps and other benign lesions

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28
Q

What investigation may be useful in identifying potential endometrial hyperplasia prior to biopsy?

A

Transvaginal USS

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29
Q

Can an endometrial biopsy be performed regardless of transvaginal USS results?

A

Yes, if clinical suspicion is high

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30
Q

What does the interpretation of the results of a transvaginal USS for suspected endometrial hyperplasia depend upon?

A

Whether she is pre- or post-menpausal

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31
Q

Which group of women is endometrial thickness on transvaginal USS less helpful in determining likelihood of endometrial hyperplasia?

A

Pre-menopausal women

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32
Q

Why is endometrial thickness less helpful in pre-menopausal women?

A

Due to the cyclical change and overlap between normal proliferative endometrium and hyperplasia

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33
Q

What can a transvaginal USS in pre-menopausal women help to identify (other than endometrial hyperplasia)?

A

Abnormalities such as polyps

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34
Q

What endometrial thickness in pre-menopausal women is unlikely to suggest endometrial hyperplasia?

A

<7mm

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35
Q

What can endometrial thickness in post-menopausal women be used to determine?

A

Need for biopsy/hysteroscopy

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36
Q

What is the cut off endometrial thickness for requiring endometrial biopsy/hysteroscopy in post-menopausal women?

A

3-4mm

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37
Q

What can treatment of endometrial hyperplasia include?

A
  • Conservative management
  • Hormonal therapy
  • Hysterectomy
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38
Q

What are the management options for endometrial hyperplasia without atypia?

A
  • Reassurance
  • Address risk factors
  • Watchful waiting
  • Progestogen treatment
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39
Q

What reassurance can be given to women with endometrial hyperplasia without atypia?

A

Risk of progression to cancer is <5% over 20 years and most will return to normal spontaneously

40
Q

What forms part of watchful waiting for endometrial hyperplasia without atypia?

A

6-monthly follow-up biopsies until 2 consecutive normal results

41
Q

What is the first line progestogen treatment for endometrial hyperplasia?

A

Levonorgestrel IUS

42
Q

What is the second line progestogen treatment for endometrial hyperplasia?

A

Oral progestogen

43
Q

What is the advised treatment for all women with atypical endometrial hyperplasia?

A

Hysterectomy

44
Q

Why is a hysterectomy recommended for all women with atypical endometrial hyperplasia?

A

Due to the risk of malignant progression

45
Q

What management option is available for women with atypical endometrial hyperplasia who wish to preserve their fertility?

A

Progestogens with 3-monthly endometrial biopsy and hysterectomy as soon as possible

46
Q

What is the most common presenting symptom in endometrial cancer?

A

Abnormal uterine bleeding

47
Q

What % of cases of endometrial cancer present with abnormal uterine bleeding?

A

90%

48
Q

What is the most common type of abnormal uterine bleeding seen in endometrial cancer?

A

Post-menopausal bleeding

49
Q

What are some other potential presenting features of endometrial cancer?

A
  • Lower abdominal pain
  • Vaginal discharge
  • Dyspareunia
50
Q

What is often seen on bimanual/speculum examination in endometrial cancer?

A

Often normal

51
Q

What are the symptoms of advanced disease in endometrial cancer?

A
  • Urinary frequency
  • Fatigue
  • Loss of appetite
  • Back pain
  • Constipation
52
Q

What are the differentials for endometrial cancer?

A
  • Endometrial hyperplasia
  • Endometrial polyp
  • Endometriosis
  • Cervical cancer
  • Pyometria
53
Q

What is the first line investigation for endometrial cancer in post-menopausal women?

A

Transvaginal ultrasound

54
Q

Why is transvaginal USS first line investigation in post menopausal women for endometrial cancer?

A

It can identify women at risk of endometrial hyperplasia and cancer due to thickening of the endometrium

55
Q

How does thickness of the endometrium in post-menopausal women correlate to risk?

A

Thicker = higher risk of serious pathology

56
Q

What is the usual cut off for endometrial thickness requiring further investigations?

A

3mm

57
Q

What investigations take place if transvaginal USS suggests high likelihood of endometrial pathology?

A
  • Hysteroscopy

- Endometrial biopsy

58
Q

How is definitive diagnosis of endometrial cancer/hyperplasia made?

A

Histology of biopsy sample

59
Q

How is a biopsy sample obtained in endometrial cancer?

A

Usually hysteroscopy

60
Q

What can hysteroscopy be used for?

A

Detecting polyps, other benign lesions and taking biopsies

61
Q

What is required to stage endometrial cancer?

A

Total abdominal hysterectomy

62
Q

Why else is total abdominal hysterectomy needed in endometrial cancer (other than staging)?

A

As a primary treatment

63
Q

What are the stages of endometrial cancer?

A

Stage 1-4

64
Q

What is Stage 1 endometrial cancer?

A

Disease in the body of the uterus

65
Q

What is Stage 1a endometrial cancer?

A

Invasion <50% of the myometrium

66
Q

What is Stage 1b endometrial cancer?

A

Invasion >50% of the myometrium

67
Q

What is Stage 2 endometrial cancer?

A

Disease in the body of the uterus and cervix

68
Q

What is Stage 3 endometrial cancer?

A

Disease advanced within the pelvis

69
Q

What is Stage 3a endometrial cancer?

A

Involvement of the ovaries

70
Q

What is Stage 3b endometrial cancer?

A

Involvement of the vagina and parametrium

71
Q

What is Stage 3c endometrial cancer?

A

Local lymph node involvement

72
Q

What is Stage 4 endometrial cancer?

A

Disease spread outside the pelvis

73
Q

What is Stage 4a endometrial cancer?

A

Involvement of the bowel/bladder

74
Q

What is Stage 4b endometrial cancer?

A

Involvement of more distant organs

75
Q

What is an important point to consider when managing Stage 1a endometrial cancer?

A

Whether the patient wishes to keep fertility

76
Q

What should a patient with Stage 1a endometrial cancer who wishes preserve fertility be offered before treatment?

A

Counselling

77
Q

What fertility preserving treatment can be given for Stage 1a endometrial cancer?

A

Progestogens

78
Q

What is required alongside progestogens in the treatment of Stage 1a endometrial cancer?

A

Aggressive monitoring

79
Q

What aggressive monitoring do women being treated for Stage 1a endometrial cancer with progestogens require?

A

Hysteroscopy and endometrial sampling every 3-6 months

80
Q

What should women who are having fertility preserving treatment for Stage 1a endometrial cancer have after children?

A

Hysterectomy

81
Q

What is the standard treatment for women with Stage 1a endometrial cancer that do not wish preserve fertility?

A

Total hysterectomy, bilateral salpingo-oopherectomy and node dissection

82
Q

What adjunctive therapy can be given in Stage 1a endometrial cancer if certain risk factors are present?

A

Vaginal brachytherapy

83
Q

What risk factors in Stage 1a endometrial cancer indicate vaginal brachytherapy?

A
  • Age >60
  • Lymphovascular space invasion
  • Grade 3 tumours
84
Q

How is endometrial cancer Stage 1b - 2 managed?

A

Surgery (as with Stage 1) and sometimes adjunctive therapies

85
Q

What adjunctive therapies may be given for Stage 1b - 2 endometrial cancer?

A
  • Pelvic radiation
  • Chemotherapy
  • Vaginal brachytherapy
86
Q

How is Stage 3 or 4 endometrial cancer managed?

A

Surgery followed by chemotherapy

87
Q

What additional therapy can patients with Stage 3 or 4 endometrial cancer have if they are at high risk?

A

External beam radiotherapy

88
Q

What is the main therapy for recurrent or terminal endometrial cancer?

A

Supportive care

89
Q

What should be managed in supportive care of endometrial cancer?

A
  • Pain
  • Nausea and vomiting
  • Lymphoedema
  • Bleeding
  • Obstruction
  • Fistulae
90
Q

What cancer targeted therapies can be used for incurable or recurrent endometrial cancer?

A
  • Radiotherapy
  • Surgical resection
  • Palliative chemotherapy
  • Hormonal therapy with progesterone or aromatase inhibitors
91
Q

What is the overall 20 year survival for endometrial cancer?

A

80%

92
Q

What does prognosis of endometrial cancer depend on?

A

Type and stage of tumour

93
Q

What are some poor prognostic indicators for endometrial cancer?

A
  • Older age
  • Advanced stage
  • High-grade tumours
  • Adenosquamous histology
  • Obesity
94
Q

Where is recurrence of endometrial cancer post-surgery most common?

A

The vaginal vault

95
Q

When does recurrent endometrial cancer most commonly present?

A

2-3 years after primary treatment

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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