Endometrial cancer

Question 1

What is the peak age for endometrial cancer?

Answer 1

65-75yrs

Question 2

What percentage of women develop endometrial cancer under the age of 40?

Answer 2

5%

Question 3

What is the most common type of endometrial cancer?

Answer 3

Adenocarcinoma

Question 4

Describe the characteristics of adenocarcinoma in terms of histology

Answer 4

Neoplasia of epithelial tissue that has glandular origin and/or glandular characteristics

Question 5

What causes adenocarcinoma of the endometrium?

Answer 5

Stimulation of the endometrium by oestrogen without the protective effects of progesterone - unopposed oestrogen

Question 6

What can unopposed oestrogen lead to ?

Answer 6

Endometrial cancer

Endometrial hyperplasia

Question 7

What is endometrial hyperplasia considered as?

Answer 7

Pre-cancerous state

Question 8

Give some risk factors for endometrial cancer

Answer 8

Anovulation - early menarche, late menopause, low parity, polycystic ovarian syndrome, hormone replacement therapy, tamoxifen use

Age - 65-75yrs

Obesity

Hereditary - Hereditary non-polyposis colorectal cancer (Lynch syndrome)

Question 9

Describe the clinical features of endometrial cancer

Answer 9

Post menopausal bleeding

Uncommonly - clear/white vaginal discharge or with abnormal cervical smears

If premenopausal - irregular bleeding or intermenstrual bleeding

Advanced or metastatic - abdominal pain or weight loss

Question 10

What is post menopausal bleeding

Answer 10

Bleeding one year after periods have stopped

Question 11

Describe the examination findings of endometrial cancer

Answer 11

Abdo - abdo/pelvic masses
Speculum - vulval/vaginal atrophy or cervical lesions
Bimanual examination - size and axis of the uterus prior to endometrial sampling

Question 12

Give the differential diagnoses for post-menopausal bleeding

Answer 12

Vulval causes - atrophy, pre-malignant or malignant conditions

Cervical causes - cancer or polyps

Endometrial causes - hyperplasia, benign polyps, atrophy

Question 13

Describe the investigations for endometrial cancer

Answer 13

TV USS - 1st line - endometrial thickness >5mm

Endometrial biopsy in clinic if thick endometrium seen - Pipelle biopsy to confirm presence of hyperplasia with or without atypia or malignancy

If high risk - hysteroscopy with biopsy may be performed as outpatient or under GA

If malignancy confirmed, MRI or CT to determine staging

Baseline bloods - FBC, U&Es, LFTs, G&S

Question 14

What is the staging system for endometrial cancer?

Answer 14

FIGO

Question 15

Describe the FIGO staging system

Answer 15

Stage 1 - carcinoma confined to the uterine body
Stage 2 - carcinoma may extend to cervix but not beyond uterus
Stage 3 - carcinoma extends beyond the uterus but is confined to the pelvis
Stage 4 - carcinoma involves bladder or bowel or has metastasised to distant sites

Question 16

Describe the management of endometrial hyperplasia

Answer 16

Non malignant or simple without atypia - treated with progestogens. Surveillance biopsies can be performed to identify any progression to atypia or malignancy

Atypical hyperplasia - highest rate of progression to malignancy should be treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Regular surveilence biopsies if surgery is CI

Question 17

What is the management of endometrial carcinoma dependent on?

Answer 17

Stage

Question 18

Describe the management of stage 1 endometrial carcinoma

Answer 18

Total hysterectomy and bilateral salpingo-oophorectomy
Peritoneal washings taken
Laparoscopic surgery increasingly performed

Question 19

What is the 5yr survival for stage 1 endometrial cancer

Answer 19

90%

Question 20

Describe the management of stage 2 endometrial cancer

Answer 20

Radical hysterectomy - vaginal tissue surrounding the cervix is removed, alongside supporting ligaments of the uterus and assessement and removal of pelvic lymph nodes

Question 21

What might women with confirmed carcinoma 1c or 2 be offered?

Answer 21

Adjuvant radiotherapy

Question 22

What is the management for stage 3 endometrial carcinoma?

Answer 22

Maximal de-bulking surgery plus chemotherapy and radiotherapy

Question 23

What is the management for stage 4 endometrial cancer?

Answer 23

Maximal de-bulking surgery if possible. In many stage 4 patients, a palliative approach is preferred with low dose radiotherapy and high dose oral progestogens

Question 24

For how long is frequent follow up required after surgery for endometrial carcinoma?

Answer 24

5 years