Endometrial Ca/PMB Flashcards
Incidence of PMB
7 in 1000
Risk of endometrial cancer after PMB
10%
Risk of malignancy in endometrial polyp pre-menopause
1-2%
Risk of malignancy in endometrial polyp post-menopause
5-6%
Relative risk of endometrial cancer after breast cancer
2-3x
TV USS sensitivity for detecting endometrial ca
80%
Stage 1
Confined to uterine corpus and ovary
Stage 1A
Disease limited to endometrium OR non-aggressive type OR good prognosis disease
1A1 - non aggressive type limited to endometrial polyp/endometrium
1A2 none aggressive type involving <50% myometrium with no or focal LVSI
1A3 - low grade endometrioid carcinoma limited to uterus or ovary
Stage 1B
Non-aggressive histological type with invasion >50% of myometrium with no or focal LVSI
Stage 1C
Aggressive histological type confined to endometrium or polyp
Stage 2
Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological subtype involving myometrium
Stage 2A
Invasion of cervical stroma of non-aggressive histological types
Stage 2B
Substantial LVSI of non-aggressive histological subtypes
Stage 2C
Aggressive histological types with any myometral involvement
Stage 3
Local and/or regional spread of tumour
Stage 3A
Invasion of uterine serosa and/or adnexa by direct extension or metastasis
3A1 - spread to ovary or fallopian tube
3A2 - involvement of uterine subserosa or spread through serosa
Stage 3B
Metastasis or direct spread to vagina and/or parametrium
3B1 - metastasis or direct spread to vagina/parametrium
3B2 - metastasis to pelvic peritoneum
Stage 3C
Metastasis to para-aortic or pelvic lymph nodes or both
Stage 3C1
Metastasis to pelvic lymph nodes
3C1i - micrometastasis
3C1ii - macrometastasis
Stage 3C2
Metastasis to para-aortic lymph nodes up to the renal vessels
3C2i - micrometastasis
3C2ii - macrometastasis
Stage 4
Spread to bladder mucosa/intestinal mucosa/distant sites
4A - invasion of bladder/intestine
4B - peritoneal metastasis beyond the pelvis
4C - distant mets (including intra-abdominal lymph nodes above renal vessels)
Endometrial stromal sarcomas spread to adnexa at what rate?
20-30%
Malignant mixed mullerian tumours are composed of what?
Stromal and glandular elements
Can be homologous (cell type found in uterus)
Or heterologous (extra-uterine cell type eg osteosarcoma)
Leiomyosarcomas originate from where?
Fibroids in 5-10% cases
Good prognosis
Histological subtypes of endometrial carcinoma
Endometrioid (EEC)
Serous sarcoma
Clear cell carcinoma
Mixed carcinoma
Undifferentiated carcinoma
Carcinosarcoma
Other unusual types
Gastrointestinal mucinous type carcinomas
Cut off for vessel involvement to determine extent of LVSI
> /= 5
Incidence
9000 per year
Risk factors
Obesity (5kg/m2 = 50% increase in risk)
Age (85% >55yo)
PCOS
lynch syndrome
Diabetes
HTN
Early menarche/late menopause
Nulliparity
Unopposed oestrogen therapy
Cowden syndrome
Family history
Tamoxifen
Diet
Physical inactivity
Lynch syndrome is ______
autosomal dominant DNA mismatch repair condition
Genes involved in Lynch syndrome
MSH2
MLH1
MSH6
PMS2
Lifetime risk of EC with Lynch syndrome
25-60%
Red flag symptoms
PMB
pyometra
Vaginal discharge
IMB
Persistent HMB
Abdominal distension
Pelvis pressure or pain
If on HRT then review when _______
Persistent unscheduled bleeding for 6 months OR
New onset PMB persisting 6 weeks after stopping
Pipelle biopsy EC detection rate
90-100%
Incidence of lynch syndrome
3 per 1000
Lynch syndrome is associated with the following conditions
IBD
acromegaly
5yr survival stage 1 ca
90%
5yr survival stage 2
75%
5yr survival stage 3
50%
5yr survival stage 4
15%
Surgical treatment for endometrial cancer
TAH + BSO
Could have ovarian sparing surgery if pre-menopausal and low grade/risk disease
Sentinel lymph node biopsy and omental biopsy if higher grade disease
Non-surgical treatment of endometrial cancer
If unfit - vaginal hysterectomy, pelvic radiotherapy or progestin/aromatase inhibitors
Intra-cavity brachytherapy for low grade, stage 1 tumours without deep myometrial invasion
Combined external beam radiotherapy for stage II or high grade or deep myometrial invasion
Management of FIGO stage II/IV disease
Consider Debulking surgery or limited surgery for palliation
Adjuvant therapy for low risk EC
None
Adjuvant therapy for intermediate risk disease
Vaginal vault brachytherapy
Omit for patients under 60
Adjuvant therapy for high risk disease (lymph node staging)
Vaginal vault brachytherapy alone if no LVSI
External beam radiotherapy if LVSI or high grade stage II with deep myometrial involvement
Adjuvant therapy for high intermediate risk disease (no lymph nodes)
External beam radiotherapy
Chemotherapy when LVSI is present
Brachytherapy alone for stage II low grade endometrioid cancers without deep invasion
Adjuvant therapy for high grade endometrial disease
External beam radiotherapy with adjuvant chemotherapy OR sequential chemotherapy and radiotherapy
Chemotherapy alone with vaginal brachytherapy if systematic lymphadenectomy was performed
Risk of endometrial cancer recurrence with radiotherapy alone
18%
