Endometrial Flashcards
NZ Stats 2013 and Epidemiology
Most common gynaecological cancer in NZ & the world
5th most commonly registered cancer for NZ woman after breast, colorectal, melanoma and lung
• 500 Reg
• 100 deaths
Is there is disparity between Maori and non-Maori?
Māori and Pacific Island women have higher incidence and mortality rates
What are the risk factors?
Relate to imbalance in hormones Increasing age: post-menopausal between 55 and 85yrs Changes of oestrogen and progesterone: • Early onset of menstruation • Nulliparity – never giving birth • Infertility • Late menopause • HRT – tamoxifen – breast Past medical history: • Obesity • Hypertension • Diabetes • Polycycstic ovaries
What are the signs and symptoms/clinical presentation?
Abnormal bleeding in 90% of cases • Pre/Peri or Post-menopausal - quite an obvious symptom • Abnormally heavy • Prolonged • Irregular • In-between periods • Excess blood loss can lead to anaemia Unusual discharge Abdo pain or cramping Changes in bladder & bowel habits Significant weight loss or gain
What is the most common pathology of endometrial cancer and cell type?
90% adenocarcinoma
• 95% from endometrioid cells
• 5% from serous cells
• 1-2% clear cells
How is the pathology categorised and which is more common?
Categorised as oestrogen dependent (Type 1) and oestrogen-independent (Type 2)
Type 1 is more common
Where does it spread to for local invasion?
Local Invasion:
• Uterine wall, fallopian tubes & cervix
• Myometrium or perimetrium
• Rectum & bladder
Where does it metastasise to?
Distant Metastasis: • Peritoneal seeding - Can spread within the peritoneal fluid in the peritoneal cavity - mix between local invasion and distant spread • Lung • Liver • Bone
What is its lymphatic spread?
Lymphatic Spread: • Internal iliac • Obturator • External iliac • Common iliac • PA nodes
What investigations are carried out?
- Complete history
- Internal pelvic examination
- FBC
- Tissue samples
- Trans vaginal ultrasound
- CT/MRI of pelvis/abdo (contrast)
- PET-CT
- Chest x-ray
- Bone scan for suspicious mets
What type of tissue samples can be taken?
Tissue Samples
• Vacuum aspiration biopsy
• Hysteroscopy +/- pipelle biopsy
• Hysteroscopy +/- dilatation & curettage
What is the common RT prescription used?
45-50.4Gy in 25-28# (1.8Gy/#) EBRT
What is the prescription for palliative EBRT?
20Gy/5# or 30Gy/10# - Palliative EBRT
What is the brachy prescription for both brachy alone and brachy boost post EBRT?
24Gy in 4# twice a week (Brachy alone)
8-10Gy in 2# once a week, 1 week after EBRT (Brachy Boost post EBRT)
What chemotherapy regime is used as adjuvant tmt for pts with Stage III and IV disease?
Carboplatin and Paclitaxel
What are the Acute side effects of this chemotherapy regime?
Acute: • Nausea and vomiting • Increased risk of infection • Bone marrow suppression • Alopecia • Fatigue • Weight loss/loss of appetite • Numbness in hands or feet • Aching joints or muscles • Taste changes
What are the Late effects of this chemotherapy regime?
Late: • Cardiotoxicity • Nephrotoxicity • Hepatotoxicity • Peripheral Neuropathy • Tinnitus • Infertility
What are the characteristics of Type 1?
- Majority of endometrial carcinomas
- Diagnosed at low histological level
- Favourable prognosis
What are the characteristics of Type 2?
- Less common - serous and clear cell carcinomas
- Diagnosed at high stage - more aggressive
- Poorer outcomes
What does hormone therapy depend on?
Whether the disease is Type 1 or Type 2
When is hormone therapy used?
For recurrent or advanced endometrioid disease. Last resort to gain some control.
What does the response to hormone therapy depend on?
Dependent on the expression of oestrogen and progesterone receptors
What hormone therapy agents are used?
Progesterones are the most common agent:
- MPA or MA
Anti-oestrogens:
- Tamoxifen
What are the side effects of hormone therapy?
- Hot flushes
- Night sweats
- Weight gain
- Risk of blood clots
- Fluid retention
