Endometrial cancer Flashcards
What is the peak age for endometrial cancer?
65-75yrs
What percentage of women develop endometrial cancer under the age of 40?
5%
What is the most common type of endometrial cancer?
Adenocarcinoma
Describe the characteristics of adenocarcinoma in terms of histology
Neoplasia of epithelial tissue that has glandular origin and/or glandular characteristics
What causes adenocarcinoma of the endometrium?
Stimulation of the endometrium by oestrogen without the protective effects of progesterone - unopposed oestrogen
What can unopposed oestrogen lead to ?
Endometrial cancer
Endometrial hyperplasia
What is endometrial hyperplasia considered as?
Pre-cancerous state
Give some risk factors for endometrial cancer
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)
Describe the clinical features of endometrial cancer
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
What is post menopausal bleeding
Bleeding one year after periods have stopped
Describe the examination findings of endometrial cancer
Abdo - abdo/pelvic masses
Speculum - vulval/vaginal atrophy or cervical lesions
Bimanual examination - size and axis of the uterus prior to endometrial sampling
Give the differential diagnoses for post-menopausal bleeding
Vulval causes - atrophy, pre-malignant or malignant conditions
Cervical causes - cancer or polyps
Endometrial causes - hyperplasia, benign polyps, atrophy
Describe the investigations for endometrial cancer
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
What is the staging system for endometrial cancer?
FIGO
Describe the FIGO staging system
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
Describe the management of endometrial hyperplasia
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
What is the management of endometrial carcinoma dependent on?
Stage
Describe the management of stage 1 endometrial carcinoma
Total hysterectomy and bilateral salpingo-oophorectomy
Peritoneal washings taken
Laparoscopic surgery increasingly performed
What is the 5yr survival for stage 1 endometrial cancer
90%
Describe the management of stage 2 endometrial cancer
Radical hysterectomy - vaginal tissue surrounding the cervix is removed, alongside supporting ligaments of the uterus and assessement and removal of pelvic lymph nodes
What might women with confirmed carcinoma 1c or 2 be offered?
Adjuvant radiotherapy
What is the management for stage 3 endometrial carcinoma?
Maximal de-bulking surgery plus chemotherapy and radiotherapy
What is the management for stage 4 endometrial cancer?
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
For how long is frequent follow up required after surgery for endometrial carcinoma?
5 years
