Endometrial Cancer

Question 1

What is endometrial cancer?

Answer 1

Cancer of the endometrium of the uterus

Question 2

Who is normally affected by endometrial cancer?

Answer 2

Post-menopausal women

Question 3

How many women are affected before menopause?

Answer 3

25%

Question 4

What is the prognosis of endometrial cancer?

Answer 4

Good

Question 5

What are the 2 categories of endometrial cancer?

Answer 5

Endometrioid adenocarcinoma

Uterine serous and clear cell carcinoma

Question 6

What is the commonest type of endometrial cancer?

Answer 6

Endometrioid adenocarcinoma

Question 7

Which type of endometrial cancer has a worse prognosis?

Answer 7

Serous and clear cell carcinoma

Question 8

Who does serous and clear cell carcinoma usually affect?

Answer 8

Older women

Question 9

What leads to an increased risk of endometrial cancer?

Answer 9

Exposure to unopposed oestrogen

Question 10

What causes increased unopposed oestrogen?

Answer 10

• Nulliparity
• Obesity
• Early menarche
• Late menopause
• Polycystic ovary syndrome

Question 11

What reduces the risk of the increased oestrogen ?

Answer 11

Progesterone

Question 12

What is the classic symptom of endometrial cancer?

Answer 12

Postmenopausal bleeding

Change in intermenstrual bleeding in premenopausal women

Question 13

What are unusual features of endometrial cancer?

Answer 13

Pain and discharge

Question 14

What is the first line investigation for endometrial cancer?

Answer 14

Trans-vaginal ultrasound

Question 15

What predictive value does a normal endometrial thickness have?

Answer 15

A high negative predictive value

Question 16

How is the diagnosis of endometrial cancer confirmed?

Answer 16

Hysteroscopy with endometrial biopsy

Question 17

What is the management of endometrial cancer dependent on?

Answer 17

The stage of the cancer

Question 18

What is the management of endometrial cancer confined to the uterus?

Answer 18

Hysterectomy with bilateral Salpingo-oophorectomy

Question 19

What is the management of cancer spread outside the uterus?

Answer 19

Combination chemotherapy and radiotherapy

Question 20

What is the management of a frail, elderly lady who isn’t fit for surgery?

Answer 20

Progesterone therapy

Question 21

What is used for palliation?

Answer 21

Progesterone

Question 22

What is 1A staging?

Answer 22

Inner half of myometrium

Question 23

What is 1B staging?

Answer 23

Outer half of myometrium

Question 24

What is 2 staging?

Answer 24

Invades cervix

Question 25

What is 3A staging?

Answer 25

Serosa

Question 26

What is 3B staging?

Answer 26

Vagina

Question 27

What is 3C staging?

Answer 27

Pelvic or para-aortic lymph nodes

Question 28

What is 4 staging?

Answer 28

Bladder/ Bowel/ Intra-abdominal/ Inguinal nodes

Question 29

What are the protective factors against endocmtrial cancer?

Answer 29

Smoking
COCP
Mulitparity

Question 30

What condition is associated with endometrial cancer?

Answer 30

PCOS

Question 31

What gene is associated with an increased risk of endocmetrial cancer?

Answer 31

HNPCC

Colorectal cancer

Question 32

What hormonal drug therapy is associated with an increased risk of endometrial cancer?

Answer 32

Tamoxifen

Question 33

Which women should be referred down the suspected cancer pathway?

Answer 33

All women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway

Question 34

What would you see on an TV ultrasound that would cause suspicion of endometrial cancer?

Answer 34

Endometrial thickness >4mm

<4mm has a negative predictive value