Cancer

Question 1

Risk factors for endometrial carcinoma:

Answer 1

obesity
nulliparity
early menarche
late menopause
unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
diabetes mellitus
tamoxifen
polycystic ovarian syndrome

Question 2

Symptoms of endo ca:

Answer 2

post-menopausal bleeding is the classic symptom
pre-menopausal women may have a change intermenstrual bleeding
pain and discharge are unusual features

Question 3

Investigations when suspecting endometrial ca:

Answer 3

first-line investigation is trans-vaginal ultrasound - a normal endometrial thickness (< 4 mm) has a high negative predictive value
hysteroscopy with endometrial biopsy

Question 4

Management of endometrial ca:

Answer 4

localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy. Patients with high-risk disease may have post-operative radiotherapy
progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery

Question 5

What is protective for endometrial ca?

Answer 5

The contraceptive pill.