Endometrial cancer

Question 1

What is endometrial cancer

Answer 1

Malignancy from endometrial tissue - 2nd most common gynea cancer
Uncommon under 40, but any PMB needs to be proven otherwise

90% adenocarcnimas

RF - see endometrial hyperplasia but mainly oestrogen

2 types -
type 1 (85%)- SEM (secretory endometrioid mucinous carcioma)- younger, oestrogen depedent, superficial invade, low grade
(PTEN, PI£KCA assocaite)

type 2 - 15% -SC (uterine papullary serous carcinoma)
Older patients, less oestrogen dependent, deeper invasion, higher grade

Question 2

Sx and Ix of Endometrial cancer

Answer 2

Most present early on - PV bleed (often PMB) -always treat PMB as endometrial cancer
bulky uterus,

metastase to paraaortic LN (unlike cervix to illiac)

Ix-
TVUSS-
<4mm -unlikely
>4mm- 2nd line hysterscopy and biopsy

Stage with CT CAP >Mri -

Question 3

Mx and prognosis of endometrial cancer

Answer 3

Use Figo staging *via CTCAP),

stage 1 - total abdominal hysterctomy, bilateral salpingoopherectomy

stage 2+ (>50 mymetrial invasion)
- radical hystectomy,

chemo is limited use- only if radio not working

Hormone - high dose oral/intrauterine progestine
if - pre-cancerous complex atypical hyperplasia
surgery still better than hormones

Prog-
5y survival - 80%
bad features - old, deep, grade 3. distant metasais
Expression of HER2 can improve