CPC Of The Uterus

Question 1

What are the key components of a history and investigation of post menopausal bleeding?

Answer 1

Post menopausal bleeding is a red flag symptom: investigate with a trans vaginal US for thickness and contour, endometrial biopsy (gives histology)

History for high circulating oestrogen eg obesity, unopposed E2 therapy/tamoxifen, PCOS, early menarche-late menopause

Histology for atypical endometrial hyperplasia

History for HNPCC/Lynch type 2 familial cancer syndrome

Question 2

How do you manage endometrial cancer?

Answer 2

Staging done surgical/pathological
FIGO 2009: 1A, 1B, 2, 3A, 3B, 3C, 4
Use of MRI

Treatment

• early stage: surgery TAH/BSO/washings
• high risk histology: chemotherapy
• advanced stage: radiotherapy
• palliation: progesterone

TAH: total abdominal hysterectomy with removal of tubes and ovaries and peritoneal washings

Question 3

What is the relevance and significance of a histological diagnosis of endometrial cancer?

Answer 3

Histological type
1) emdometrioid adenocarcinoma

Significance: common, unopposed oestrogen, hyperplasia with atypical precursor

2) uterine serous & clear cell carcinoma

Significance: high grade, more aggressive, worse prognosis, generally older, serous intraepithelial carcinoma precursor