Clinical Pathology of Uterus Flashcards
What are the investigations of post-menopausal bleeding?
Pelvic examination
Speculum examination
Transvaginal ultrasound
Endometrial biopsy if > 4mm or irregular, blind biopsy e.g. pipelle
Hysteroscopy - outpatient with local anaesthetic or inpatient with GA
What are the advantages and disadvantages of hysteroscopy?
Allows visualisation of biopsy site
Risk of uterine rupture
Carries more risks
In what women does endometrial cancer typically occur in?
Post-menopausal women Women with high circulating oestrogen levels; - obesity - unopposed E2 therapy/tamoxifen - polycystic ovarian syndrome - early menarche/late menopause Atypical endometrial hyperplasia HNPCC/Lynch type II familial cancer syndrome
How many new cases of endometrial cancer were there in the UK in 2014?
9324
What is the incidence of endometrial cancer in the UK?
- 8 per 100,000 women
1. 0 per 100,000 women aged 40
What is the mortality of endometrial cancer in the UK?
6.7 deaths per 100,000 women
What is the 5 year survival of stage 1 endometrial cancer?
95%
What is the 5 year survival of stage 4 endometrial cancer?
14%
What is the overall 5 year survival for all stages of endometrial cancer?
78%
What stage of endometrial cancer do most women present with?
Stage 1
What are the symptoms of endometrial cancer?
Abnormal vaginal bleeding - intermenstrual
Post-menopausal bleeding
What percentage of women with post-menopausal bleeding will have endometrial cancer?
8%
What are the causes of post-menopausal bleeding?
Endometrial cancer HRT Peri-menopausal bleeding Atrophic vaginitis Polyps Other cancers e.g. cervix, vulva, bladder, anal
How is endometrial cancer staged?
MRI done to help pick appropriate surgery and treatment plan
Surgical/pathological staging
What are the advantages of MRI for endometrial cancer?
Identifies;
Depth of myometrial invasion
Cervical involvement
Lymph node involvement
What is invaded in stage 1A of endometrial cancer according to FIGO 2009 staging?
Inner half of myometrium
What is invaded in stage 1B of endometrial cancer according to FIGO 2009 staging?
Outer half of myometrium
What is invaded in stage 2 of endometrial cancer according to FIGO 2009 staging?
Invades cervix
What is invaded in stage 3A of endometrial cancer according to FIGO 2009 staging?
Serosa/adnexa
What is invaded in stage 3B of endometrial cancer according to FIGO 2009 staging?
Vagina/parametrium
What is invaded in stage 3C of endometrial cancer according to FIGO 2009 staging?
Pelvic or para-aortic nodes
What is invaded in stage 4 of endometrial cancer according to FIGO 2009 staging?
Bladder/bowel/intra-abdominal/inguinal nodes
What are the features of type 1 endometrial cancer?
Endometrioid adenocarcinoma
By far the commonest
Unopposed oestrogen
Hyperplasia with atypia is a precursor
What are the features of type 2 endometrial cancer?
Uterine serous and clear cell carcinoma
High grade, more aggressive, worse prognosis
Generally older women
Serous intraepithelial carcinoma is a precursor
What is the treatment of early stage endometrial cancer?
Surgery
TAH/BSO/washings
What is the treatment of high risk histology endometrial cancer?
Chemotherapy and surgical management
What is the treatment of advanced stage endometrial cancer?
Radiotherapy - spread within pelvis, not suitable for surgery
What is the palliative treatment of endometrial cancer?
Progesterone
What are the features of radiotherapy for treatment of endometrial cancer?
External beam radiotherapy
Treat the whole of the pelvis, tumour and lymph nodes
Followed by brachytherapy to target actual tumour
What are the features of caesium insertion for treatment of endometrial cancer?
Intra-cavity
Vault
Applicator put directly into vagina to deliver radiotherapy locally
What is the cure rate of stage 1B endometrial cancer?
85%
What is the cure rate of stage 2A endometrial cancer?
75%
What is the cure rate of stage 2B endometrial cancer?
60%
What is the cure rate of stage 3B endometrial cancer?
30%
What is the cure rate of stage 4 endometrial cancer?
21%
