Endometrial and vulval cancers Flashcards
What are the two main types of endometrial cancer? What is the most common type of endometrial cancer?
Oestrogen-dependent (endometrioid) and oestrogen-independent cancers.
Most common type - oestrogen-dependent adenocarcinoma, arising from glandular lining of endometrium
What is the pre-malignant condition for type 1 endometrial cancer? What stage of this condition is most likely to lead to cancer? What is another name for this stage of the condition
Endometrial hyperplasia (a thickened lining of the uterus +/- atypia).
Complex hyperplasia + atypia (also called intraepithelial endometrial neoplasia, IEN) = 40% chance of co-existing endometrial cancer
What is the main general risk factor for developing endometrial cancer? Name 3 specific risk factors.
Unopposed oestrogen exposure. Specific risk factors - obesity, nulliparity, anovulation (PCOS), HRT, age, delayed menopause, HT and diabetes
How can obesity lead to endometrial cancer?
Lipocytes produce aromatase, which increases the amount of circulating oestrogen
How can PCOS lead to endometrial cancer?
PCOS = anovulation = no progesterone production by corpus luteum and unopposed oestrogen = promotion of endometrial hyperplasia
What are the common features of history and examination of endometrial cancer? Name 3 differentials.
Hx - post-menopausal bleeding (an irregular bleed greater than 12 months after last period) - 5-10% of PMBs are from endometrial Ca, abnormal menstruation/vaginal bleeding in pre-menopausal woman
Ex - pelvic exam (may detect uterine mass, fixed uterus, or adnexal mass)
Ddx - atrophic vaginitis (most common, inflammation of vagina due to thinning and shrinking of tissues during menopause), uterine polyps (2nd most common), perimenopausal, cervical Ca
What is the first investigation to do if suspicious of endometrial cancer? What result is suggestive of the disease? If positive, what investigation should you do next?
Transvaginal U/S - >5mm endothelial thickness in post-menopausal woman suggestive of disease. Pre-menopausal, anything up to 25mm can be normal depending on stage of cycle.
If positive, then do Pipelle catheter (lower sensitivity) or D&C hysteroscopy to biopsy tissue
What is the standard management for someone with diagnosed endometrial cancer?
Hysterectomy +/- resection of inguinal lymph nodes
Name 2 risk factors for vulval cancer
HPV infection
Smoking
What are the two types of precursor lesions for vulval cancer? How does presentation of a vulval cancer differ between the two?
VIN (vulval intraepithelial lesion) - usually superficial, easy to see and smell (necrotic) Lichen sclerosus (irritative auto-immune condition causing symmetrical resorption of vulval tissue - labia minora, clitoris) - cancer hides under thickened tissue, can be harder to see.
