Endometrial Cancer Flashcards
What is endometrial cancer?
It is defined as the proliferation of malignant cells in the endometrium
What is the most common classification of endometrial cancer?
Adenocarcinoma
What is the pathophysiological cause of endometrial cancer?
Unopposed oestrogen
This results from an endogenous or exogenous lack of progesterone
What are the thirteen risk factors associated with endometrial cancer?
Post-Menopausal
Nulliparity
Early Menarche
Late Menopause
Breast Cancer
Polycystic Ovarian Syndrome
Diabetes Mellitus
Obesity
Hypothyroidism
Hypertension
Lynch Syndrome
Oestrogen HRT Administration
Tamoxifen Administration
What are the six protective factors associated with endometrial cancer?
Multiparity
Combined Oral Contraceptive Pill
Aspirin
Exercise
Smoking
Caffeine Intake
What are the six clinical features of endometrial cancer?
Vaginal Bleeding
Vaginal Discharge
Vaginal Dryness
Pyometra
Pelvic Pain
Weight Loss
What three types of vaginal bleeding are associated with endometrial cancer?
Post menopausal bleeding
Heavy menstrual bleeding
Inter menstrual bleeding
What is pyometra?
It is defined as a collection of pus in the uterine cavity
What two clinical features indicate advanced endometrial cancer?
Pelvic Pain
Weight Loss
What five investigations are used to diagnose endometrial cancer?
Blood Tests
Transvaginal Ultrasound
MRI Scans
Endometrial Biopsy
Hysteroscopy
What three blood test results indicate endometrial cancer?
Decreased Haemoglobin Levels
Decreased Platelet Levels
Increased Ca-125 Levels
When are transvaginal ultrasound scans used to diagnose endometrial cancer?
They are the first line investigation, which should be conducted as an urgent referral in all women over 55 years old who present with postmenopausal bleeding
What are the two features of endometrial cancer on transvaginal ultrasound scans?
Endometrial Thickness > 4mm
Irregular Endometrial Contour
How are MRI scans used to diagnose endometrial cancer?
They are used to confirm the diagnosis of endometrial cancer and determine its staging
When are endometrial biopsies used to diagnose endometrial cancer?
A positive transvaginal ultrasound scan of endometrial thickness > 4mm
OR
In cases of persistent bleeding in those with an endometrial thickness < 4mm
When are hysteroscopies be to investigate endometrial cancer?
High risk cases
OR
Multiple high risk factors
OR
Significant endometrial thickness
What criteria is used to stage endometrial cancer?
International Federation of Gynaecology & Obstetrics (FIGO) Staging System
What is stage one endometrial cancer?
This is defined as endometrial cancer limited to the body of the uterus
What is stage two endometrial cancer?
This is defined as endometrial cancer limited to the body of the uterus and cervix
What is stage three endometrial cancer?
This is defined as endometrial cancer which extends to the uterine serosa, peritoneal cavity and/or lymph nodes
What is stage four endometrial cancer?
This is defined as endometrial cancer which extends to the vagina or parametrium
What is the management option of stage one endometrial cancer?
Total hysterectomy and bilateral salpingooophorectomy, plus peritoneal washings
What is total hysterectomy and bilateral salpingooophorectomy?
It involves removal of the uterus, cervix and adnexa
What is the management option of stage two A endometrial cancer?
Total hysterectomy and bilateral salpingooophorectomy, plus peritoneal washings
What is the management option of stage two B endometrial cancer?
Exploratory laparotomy with Wertheim’s radical hysterectomy
What is exploratory laparotomy with Wertheim’s radical hysterectomy?
It involves removal of the uterus, cervix, vaginal tissue and pelvic lymph nodes
What is the management option of stage three endometrial cancer?
Exploratory laparotomy with maximal de-bulking surgery
In most cases, surgical management is followed by radiotherapy or chemotherapy
What is the management option of stage four endometrial cancer?
Palliative care, involving tumour debulking, chemotherapy and hormonal therapies
What are the four chemotherapy agents used to manage endometrial cancer?
Doxorubicin
Pacilaxel
Carboplatin
Cisplatin
What are the two hormonal therapies used to manage endometrial cancer?
Progesterone
Tamoxifen
What progesterone pill is used to manage endometrial cancer?
Provera
What is endometrial hyperplasia?
It is a precancerous condition, in which there is abnormal thickening of the endometrium
What are the two classifications of endometrial hyperplasia?
Endometrial Hyperplasia Without Atypia
Atypical Endometrial Hyperplasia
What is the malignancy risk in endometrial hyperplasia with atypia?
Low
What are the two management options of endometrial hyperplasia without atypia?
Oral progesterone
Progesterone intrauterine system
What is the malignancy risk in atypical endometrial hyperplasia?
High
What is the management option of atypical endometrial hyperplasia?
Total abdominal hysterectomy and bilateral salpingooophorectomy
