CPC uterus

Question 1

what is measured on trans-vaginal USS for post-menopausal bleeding

Answer 1

measure endometrial thickness
look at endometrial contour
biopsy if >4mm/irregular

Question 2

name 4 pathological prognostic features

Answer 2

1. histological type
2. histological grade
3. stage
4. lymphovascular space invasion (LVSI)

Question 3

how is histological type determined

Answer 3

microscopy +/- ancillary tests

Question 4

how is histological grade determined

Answer 4

microscopy

Question 5

how is stage determined

Answer 5

how far tumour has spread

based on surgical resection w/ assessment of entire uterus and adjacent organs

Question 6

how is LVSI determined

Answer 6

microscopy of resection specimen

Question 7

type 1 endometrial cancer

Answer 7

• endometrioid adenocarcinoma
• most common
• unopposed oestrogen
• hyperplasia w/ atypia precursor

Question 8

type 2 endometrial cancer

Answer 8

• uterine serous and clear cell carcinoma
• high grade, more aggressive, worse prognosis
• generally older women
  
  • serous intraepithelial carcinoma precurso

Question 9

what is shown in this histological image

Answer 9

endometrial hyperplasia with atypia

Question 10

classification of endometrial cancer - changes

Answer 10

in the future - likely to be based on molecular findings

pathologists will perform molecular testing on tumour tissue to look for certain mutations and genetic aberrations e.g p53 mutation, microsatellite instability

Question 11

how is endometrial cancer staged

Answer 11

• surgical/pathological
• MRI
  
  • depth of myometrial invasion
  • cervical involvement
  • LN involvement

Question 12

treatment of endometrial cancer

Answer 12

early stage - surgery TAH/BSO/washings (hysterectomy and bilateral salpingoophorectomy)

high risk histology - add in chemotherapy

advanced stage - radiotherapy for disease control of palliation of symptoms

palliation - progesterone

Question 13

endometrial cancer cure rates - 5YS

Answer 13

IB - 85%

IIA - 75%

IIB - 60%

IIIB - 30%

IV - 21%

Question 14

when is endometrial cancer seen

Answer 14

• post menopausal women
• high circulating oestrogen levels
  
  • obesity
  • unopposed E2 therapy/tamoxifen
  • PCOS
  • early menarche/late menopause
• endometrial hyperplasia w/ atypia
• HNPCC/lynch type II familial cancer syndrome

Question 15

why does obesity lead to high circulating oestrogen

Answer 15

peripheral conversion of androgens in body fat into a weak oestrogen

Question 16

endometrial cancer symptoms

Answer 16

abnormal vaginal bleeding

post menopausal bleeding - 8% of women w/ PMB have endometrial cancer (important to exclude)

Question 17

causes of PMB

Answer 17

endometrial cancer

HRT

peri-menopausal bleeding

atrophic vaginitis - older women

cervical/endometrial polyps

other cancer - cervix, vulva, bladder, anal

Question 18

incidence of uterine cancer

Answer 18

3% of all cancers

peak age 75-79y/o

57% increased rates since 1990s