Endometrial CA

Question 1

Epidemiology of endometrial CA (EC)

Answer 1

• 4th most common cancer in females in UK
• 6th in the world

Question 2

Overall risk of EC

Answer 2

3%
9-10% if obese

60% inc risk w every rise of 5 in BMI
Lifetime risk of 10-15% BMI>40

Question 3

RF for EC

Answer 3

• Obesity
• Age
• Early menarrche/late menopause
• P0
• PCOS
• Smoking
• Diabetes/HTN
• Tamoxifen

Question 4

Symptoms of EC

Answer 4

• PMB
• Irregular bleeding
• Bleeding on HRT
• Abnormal vaginal discharge
• Haematuria

Question 5

RF for endometrial CA

Answer 5

• Obesity
• Lynch syn (3% of endo CA)
• BRCA gene- controversial
• EH w atypia

Question 6

Lynch testing

Answer 6

• Offer to all women w EC

Question 7

Lynch risks

Answer 7

• Highest risk of colorectal CA
• 60% risk of EC
• 10% risk of ovarian CA

Question 8

Monitoring for lynch

Answer 8

• Yearly screening (TVS+ hysteroscopy) from 35yo
• Protective TLH +BSO (due to ovarian CA risk), once family complete
• Offer HRT

Question 9

Prognostic determinants of EC

Answer 9

• p53 - if loss of function, poor prog
• FIGO staging

Question 10

Type of cancer

Answer 10

• 75-80% are adenocarcinoma
• Type 1- Low grade due to estrogen
• Type 2- high grade not related to oestrogen

Question 11

Diagnosis of EC

Answer 11

• Speculum
• TVUS
• Hysteroscopy and biopsy - if pipelle used, has to be at least 4cm in.

Nice advises only hysteroscopy.

Question 12

ET cut off on TV US

Answer 12

• If <4mm and normal then low risk for CA.
• On HRT - ET <7mm

Question 13

Further scan for staging

Answer 13

• MRI
• XR or CT chest
• If high risk histology for CT TAP

Question 14

Mx of EC

Answer 14

• Discuss at MDT
• Consider performance status
• TLH +BSO or BS (if premenopause + <50% myometrial invasion)

Question 15

Enhanced recovery criteria

Answer 15

• Pre op calorie drink
• Clear fluids till surgery
• Intra-op fluid mx
• Non-opiod analgesia
• Early mobilization and feeding

Question 16

If fertility needed

Answer 16

• High dose medroxyprogesterone 200mg TDS or Mirena
• 3 monthly f/u w biopsy +imaging

Question 17

If not fit for surgery

Answer 17

• Consider VH + pelvic radiotherapy
• EBRT/brachytherapy
• Progestin if not suitable for any of above.

Question 18

FIGO Staging

Question 19

Centre to operate

Answer 19

• Stage IA- local unit can operate
• IB and above- specialist centre

Question 20

Lymphadenectomy

Answer 20

• NOT for low risk EC
• SLNB not advised
• Stage 3 and above- debulking needed + adjuvant chemo/brachy

Question 21

Adjuvant treatment

Answer 21

• Not for low risk
• Consider if high-intermediate risk
• Omit brachy for pt <60yo

Question 22

High-intermediate risk dx

Answer 22

• No LVSI- Consider adj vaginal brachy
• EBRT for Substantial LVSI/stage II or more/ deep myometrial invasion

If lymph nodes not sampled:
- Adj EBRT w or wo adj chemo
- Brachy for low grade stage II without deep invasion

Question 23

Consider chemo (carboplatin-paclitaxel) if

Answer 23

• Stage III or IV
• Myoinvasive stage I or II
• If clear cell or undifferentiated EC
• Stage 1 p53 abn

Do not use chemo if POLmut EC

Question 24

F/u post treatment

Answer 24

• Telephone or F2F
• Tell pt red flag symptoms
• F/u every 3-4m for 2 years (high risk for recur)
• Then yearly for at least 3 years (<7% recur risk)

Question 25

Sarcoma risks (2% of cancers)

Answer 25

- Highly malignant - Look like fibroids

Question 26

Risk of fibroids being sarcoma per age

Answer 26

- <50yo 2.5/1000 - 51-60yo 6/100 - >60yo 15/1000

Question 27

Mx of sarcoma

Answer 27

- Total hysterectomy +BS/BSO (low risk of ovarian mets) - Lymph not needed to stage - Do not use HRT post op

Question 28

Advanced/metastatic sarcoma mx

Answer 28

- Chemo - Doxorubicin w Gemcitabine/Docetaxel - Anti- estrogen therapy- Aromatase inhibitor or progesterone

Question 29

Adjuvant treatment

Answer 29

- Do not use radiotherapy - Offer chemo for stage III/IV