Endometria cancer and hyperplasia Flashcards
What is the most common kind of endometrial cancer
Adenocarcinoma
What presentation is endometrial cancer until proven otherwise
Postmenopausal bleeding
Key risk factors for endometrial cancer
Obesity and diabetes
What affect does oestrogen have on adenocarcinoma
Oestrogen-dependent - stimulates growth of endometrial cancer cells
What is endometrial hyperplasia
Precancerous thicking of endometrium (<5% -> cancer, most resolve)
Types of endometrial hyperplasia to be aware of
Hyperplasia without atypia
Atypical hyperplasia
What are most of the risk factors for endometrial hyperplasia based around
Exposure to oestrogen without progesterone (unopposed oestrogen)
Risk factors for endometrial cancer
Exposure to unopposed oestrogen eg
Increased age
Earlier onset menstruation
Late menopause
Oestrogen only HRT
no or fewer pregnancues
Obesity
PCOS
tamoxifen
How does PCOS increase risk of endometrial cancer
Lack of ovualtion, lack of corpus luteum that produces progesterone + therefore endometrial protection during luteal phase (second half menstrual cycle)
Insulin resistance and increased production
How should women with PCOS have endometrial protection
COCP
Intrauterine system eg mirena coil
Cyclical progesterons to induce withdrawal bleed
Why does obesity increase risk of endometrial cancer
Adipose tissue produces oestrogen - primary source in postmenopausal women
How is adipose tissue oestrogen producing
Contains aromatase, breaks down androgens eg testosterone into oestrogen
WHat effect does tamoxifen have on breast tissue vs endometrium
Anti-oestrogenic on breast tissue
Oestrogenic risk on endometrium - increase cancer risk
What risk factors for endometrial cancer unrelated to unopposed oestrogen
T2DM
Hereditary nonpolyposis colorectal cancer or lynch syndrome
How does T2DM increase endometrial cancer risk
Increased insulin which stimulates endometrial cells and increase risk of endometria hyperplasia and cancer
Protective factors against endometrial cancer
COCP
Mirena coil
Increased pregnancies
Smoking - anti-oestrogenic effect
Endometrial cnacer presentation
Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
When does NICE recommend a transvaginal US in women >55
Unexplained vaginal discharge
Visible haematuria
What investigations for diagnosing endometrial cancer
Transvaginal US for endometrial thickness
Pipelle biopsy
Hysteroscopy w endometrial biopsy
What is normal in postmenopausal woman on transvaginal US
<4mm
When is pipelle biopsy used over hysteroscopy
Wuicker and less invasive for lower risk women
Staging used for endometrial cancer
The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage endometrial cancer:
* Stage 1: Confined to the uterus
* Stage 2: Invades the cervix
* Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
* Stage 4: Invades bladder, rectum or beyond the pelvis
What is the usual treatment for stage I and 2 endometrial cancer
Total abdominal hysterectomy with bilateral salpingo-oopherectomy
eg TAH and BHO - removal of uterus, cervix and adnexa
What are the treatment options for endometrial cancer
Radical hysterectomy also removing pelvic lymph nodes, surrounding tissues and top of vagina
Radiotehrapy
Chemotherapy
Progesterone - slow progression
What are progestogens and what are they used for
Intrauterine system - mirena coil
Continous oral progesterogens eg medroxyprogesterone or levonorgestrel
