Endometrial cancer Flashcards
What is endometrial cancer?
Malignancy arising from lining of uterus (endometrium)
What is the aetiology of endometrial cancer?
Aetiology unclear, but involving OES stimulaiton of endometrium.
· Exogenous: OE HRT, Tamoxifen.
· Endogenous: Nullipatiry or infertility, early menarche or late menopause (also anovulatory cycles), obesity (aromatisaiton of fat derived peripheral androgens), PCOS, Oestrogen producing tumors (granulosa/thecal).
· Other: HPNCC (Colon cancer)
What is the epidemiology of endometrial cancer?
2nd most common gynaecological malignancy. Lifetime risk 1%. >40yo.
What is the history/ exam of endometrial cancer?
PMG, postmenopausal bleeding, PV discharge (offensive)
Normal exam unless advanced. ?bulky uterus on BMEx.
What is the pathology of endometrial cancer?
Histology: 80% adenocarcinoma, 20% uterine papillary serous, mucinous, clear cell, squamous or mixed. Endometria hyperplasia with atypia is premalignant.
SpreaD: direct and lymphatic.
Staging: I-IV. Ia/b 50% myometrial invasion (above or below). II invaidng cervical stroma. III local or regional spread. IIIb vaigna or parametrium. IV bladder or bowel mucosa.
What investigations would you do for endometrial cancer?
Tissue diagnosis: pipelle biopsy/hysteroscopy or biopsy.
Blood: FBC, UE, FLT, GS.
Imaging: pelvic USS shows thickened endometrium, investigate if >4mm in postmenopause,
MRI to stage, depth of myometrial invasion and pelvic lymphadenopathy.
CXR for metastases
What is the management of endometrial cancer?
Surgery: Stage I TAH/BSO with peritoneal washing. I/III modified radical or radical hysterectomy.
Radiotherapy: II and above adjuvant. EB and vault brachytherapy. Chemo palliative.
What are the complications/ prognosis of endometrial cancer?
Metastases, surgical morbidity, complications form radiotherapy. 5y sr 80%/70%/40%.
