Endometrial ca

Question 1

What is the cause of endometrial carcinoma?

Answer 1

The prolonged exposure to oestrogen which causes unopposed endometrial proliferation and hyperplasia which can lead to carcinoma

Question 2

What are the two types of endometrial carcinoma?

Answer 2

Type 1-caused by prolonged oestrogen stimulation

Type 2-more familial association and caused by strophic endometrium

Question 3

What are the risk factors for developing endometrial carcinoma?

Answer 3

1. Obesity-conversion of androgens to oestrogen
2. Nulliparity and infertility because of increased exposure to oestrogen
3. Late menopause-after 52 years and early menarche
4. HRT-Make sure the women takes progesterone for a minimum of 11 days to combat the oestrogen
5. Women with PCOS-anovulatory
6. Family history of Lynch syndrome
7. Tamoxifen use in breast ca patients
8. Hypertension, DM

Question 4

What is the normal menstrual cycle?

Answer 4

Proliferation phase with oestrogen and the secretory phase with progesterone

Question 5

What is the most common histology of endometrial ca?

Answer 5

Adenocarcinoma 60-80%

Question 6

What are the histological types of endometrial ca?

Answer 6

1. Adenocarcinoma
2. Adenocarcinoma with squamous hyperplasia
3. Clear cell carcinoma which originates from the Müllerian ducts

Question 7

What are the symptoms of endometrial ca?

Answer 7

1. Post-menopausal bleeding-any PMB is malignant until proven otherwise
2. Vaginal discharge purulent caused by infection of the tumour itself
3. Pain which is a late sign

Question 8

What is the spread of the ca?

Answer 8

1. Direct spread
   - laterally: endometrium, myometrium, adnexa, abdomen
   - vertically: cervical glands to the vagina wall
   - anteriorly/posteriorly: bladder, pouch of Douglas

Question 9

What is the lymphatic spread of the ca?

Answer 9

If the carcinoma is more in the fungus it will be in the para-aortic LN
If the carcinoma is in the pelvic area- External iliac, internal iliac, obturator

Question 10

What is the haematogenous spread?

Answer 10

It is a late sign but Mets to the lungs, liver, bones and brain

Question 11

What examinations do you do in a patient with endometrial ca?

Answer 11

1. Speculum
2. Bimanual vaginal exam
3. Rectal exam
4. Transvaginal ultrasound: >5mm biopsy <5mm follow up