Clinical pathological conference of the uterus

Question 1

Classification: Two Distinct Categories of Endometrial Cancer

Answer 1

type 1 and 2

Question 1

Pathological Prognostic Features

Answer 1

1. Histological type
2. Histological grade
3. Stage
4. Lymphovascular space invasion (LVSI)

Question 2

TYPE 1 endometrial cancer

Answer 2

Endometrioid adenocarcinoma
By far the commonest
Unopposed oestrogen
Hyperplasia with atypia precursor

Question 3

TYPE 2 endometrial cancer

Answer 3

Uterine serous & clear cell carcinoma
High grade, more aggressive, worse prognosis
Generally older women
Serous intraepithelial carcinoma precursor

Question 4

Endometrial Cancer
Staging investigations

Answer 4

Surgical/Pathological
MRI
depth of myometrial invasion
cervical involvement
lymph node involvement

Question 5

Endometrial Cancer
Treatment

Answer 5

Early Stage
Surgery TAH/BSO/washings
High risk histology
Chemotherapy
Advanced Stage
Radiotherapy
Palliation
Progesterone

Question 6

Endometrial Cancer
Symptoms

Answer 6

Abnormal vaginal bleeding
Post menopausal bleeding (PMB)

Question 7

Post-menopausal bleeding aetiology

Answer 7

8% of women with PMB will have endometrial cancer
Hormone Replacement Therapy (HRT)
Peri-menopausal bleeding
Atrophic vaginitis
Polyps cervical/endometrial
Other cancer eg cervix, vulva, bladder,anal

Question 8

Endometrial Cancer treatment plan

Answer 8

• Post-menopausal bleeding
  Trans-vaginal scan to look at endometrial thickness and contour
  Diagnosis by histology of endometrium
  Main treatment is Total Abdominal Hysterectomy with removal of tubes and ovaries and peritoneal washings