CA Corpus

Question 1

Increasing rate, but mortality has remained the same. Why?

Answer 1

Early detection.

There is post menopausal bleeding

Question 2

Presenting symptoms of CA corpus/endometrial cancer

Answer 2

• AUB (90%) - PMB, HMB, IMB, Irregular menses
• Abnormal vaginal discharge
• Pelvic mass
• Pelvic pain
• Urinary or bowel symptoms
• Symptoms from metastasis - SOB if lung mets, Pain if bone mets
• Constitutional symptoms
• Abnormal smear - atypical glandular cells

Question 3

Mrs. Chan, 55 y/o compained of one episode of post-menopausal bleeding.

What to ask for Hx taking?

Answer 3

• PC
• Constitutional symptoms
• Menstrual Hx
• Gyn Hx, Cervical smear Hx
• Obs Hx
• FHx - endometrial, colorectal
• Sexual Hx, contraception
• Social Hx
• Risk factors of endometrial cancer

Question 4

RF for endometrial cancer

Answer 4

Question 5

What is the risk of hyperplasia with non-atypical changes / hyperplasia with atypical changes developing into endometrial cancer?

Answer 5

Hyperplasia with non-atypical changes: 0-3%

Hyperplasia with atypical changes:
- Simple atypical hyperplasia turns into cancer in about 8% of cases if it’s not treated.
- Complex atypical hyperplasia (CAH) has a risk of becoming cancer in up to 29% of cases if it’s not treated

Question 6

P/E for CA corpus

Answer 6

• General
• Constitutional signs
• LN = groin, SCF
• Abdo
• PV = speculum, bimanual
• PR = rectovaginal septum, parametrium, colon

Question 7

Initial Ix for CA corpus

Answer 7

• TVS - Endometrial thickness 9mm
• Endometrial aspirate - G1 endometrioid adenocarcinoma
• Cervical smear - negative
• Mrs. Chan was referred to see a gynaecological oncologist

Question 8

What are the Ix for endometrial cancer to furthr examine the extent of disease in this patient?

Answer 8

Blood - CBP, LRFT
- CA125

Imaging
- CXR => CT thorax
- MRI abdo pelvis (preferred imaging)
- PET-CT, PET-MR

Question 9

What are the histologic subtypes?

Answer 9

• Endometrioid adenocarcinoma (Grade 1, 2, 3)

Less common:
* Serous carcinoma
* Clear cell
* Carcinosarcoma (Malignant Mixed Mullerian Tumour)
* Undifferentiated, Dedifferentiated

Question 10

Staging of endometrial cancer (FIGO)

Answer 10

Question 11

Mx of operable and inoperable CA corpus

Answer 11

Question 12

Treatment of CA coprus

Answer 12

Treatment
* TH BSO +/- lymphadenectomy ( abdominal / laparoscopic)
* Early disease ( confined to the uterus) - can do laparoscopic hysterectomy
* If LN +, need post op chemo +/ - RT
* If high risk group, even if LN -, can consider brachytherapy +/-chemotherapy
* If LN not done, give External RT if high risk

Question 13

Follow-up for CA corpus

Answer 13

• Clinical
• Tumour markers
• Imaging - clinically indicated

Question 14

Prognosis of CA corpus

Answer 14

Symptomatic at early stage
If treated early, has good prognosis

Question 15

A 55-year-old woman with good past health presented with PMB.
Hysteroscopy and curettage showed endometrioid adenocarcinoma
Grade 1. MRI showed 1.5cm endometrial tumour with superficial myometrial invasion, and no lymphadenopathy or metastasis.
* What is the most appropriate management?
A. Chemotherapy
B. Hormonal therapy
C. Radiotherapy
D. Surgery

Answer 15

D

Question 16

• A 55-year-old woman with good past health presented with PMB.
  Hysteroscopy and curettage showed endometrioid adenocarcinoma
  Grade 1. MRI showed 1.5cm endometrial tumour with superficial myometrial invasion, and no lymphadenopathy or metastasis.
• What is the most appropriate management?
  A. THBSO
  B. THBSO + PLND
  C. THBSO + PLND + PALND
  D. THBSO + PLND + PALND + omentectomy + peritoneal biopsy

Answer 16

A

Question 17

• A 55-year-old woman with good past health presented with PMB.
  Hysteroscopy and curettage showed endometrioid adenocarcinoma
  Grade 3. MRI showed 5cm endometrial tumour with deep myometrial invasion, and no lymphadenopathy or metastasis.
• What is the most appropriate management?
  A. THBSO
  B. THBSO + PLND
  C. THBSO + PLND + PALND
  D. THBSO + PLND + PALND + omentectomy + peritoneal biopsy

Answer 17

C (high risk = requires PALND)

Question 18

• A 35-year-old woman, GOPO, presented with heavy menstrual bleeding for 3 months. Physical examination was unremarkable. Endometrial aspirate showed endometrioid adenocarcinoma Grade 1. MRI showed thickened endometrium with no myometrial invasion or metastasis. She was recently married and has been trying for pregnancy.
• What is the most appropriate management?
  A. Allow to continue trying for pregnancy
  B. Progestogen
  C. Total hysterectomy, bilateral salpingectomy
  D. Total hysterectomy, bilateral salpingo-oophorectomy

Answer 18

B. Progestogen is a fertility sparing treatment for endometrial Ca (Mirena)

But D is more appropriate (must remove ovaries too as there may be risk of micrometastasis)

Question 19

• A 65-year-old woman presented with PMB and abdominal distension.
  Endometrial aspirate showed serous carcinoma. PET-CT showed 3cm endometrial tumour with multiple peritoneal deposits, moderate ascites and hypermetabolic enlarged supraclavicular, para-aortic and pelvic lymph nodes.
• What is the most appropriate management?
  A. Chemotherapy
  B. Hormonal therapy
  C. Radiotherapy
  D. Surgery

Answer 19

A

Question 20

What are the 3 factors to consider in CA corpus for extent of surgery and operability?

Answer 20

• Grade of tumor
• Size
• Myometrial invasion

Question 21

What is the postmenopausal endometrial thickness that requires EA (in theory) if asymptomatic?

Answer 21

More than 11mm endometrial thickness in USG and asymptomatic than do endometrial aspirate.

However in HA due to waiting time for USG: EA is done first prior to USG