Endometrial Cancer

Question 1

Type of endometrial cancer

Answer 1

Adenocarcinoma

Question 2

Hormonal feature of adenocarcinoma

Answer 2

Oestrogen dependent - oestrogen stimulates the growth of endometrial cancer cells

Question 3

Endometrial Hyperplasia

Answer 3

Precancerous condition involving thickening of the endometrium

Question 4

Types of endometrial hyperplasia

Answer 4

Hyperplasia without atypia

Atypical hyperplasia

Question 5

Management of endometrial hyperplasia

Answer 5

May be treated by a specialist using progestogens, with either:

• Intrauterine system (e.g. Mirena coil)
• Continuous oral progestogens

Question 6

Risk Factors of endometrial cancer

Answer 6

• Unopposed oestrogen
• Increased age
• Earlier onset of menstruation
• Late menopause
• Oestrogen only hormone replacement therapy
• No or fewer pregnancies
• Obesity
• Polycystic ovarian syndrome
• Tamoxifen

Question 7

Polycystic ovarian syndrome

Answer 7

Increased exposure to unopposed oestrogen due to a lack of ovulation forming a corpus luteum which releases progesterone

Question 8

Protection for women with PCOS

Answer 8

The combined contraceptive pill

An intrauterine system (e.g. Mirena coil)

Cyclical progestogens to induce a withdrawal bleed

Question 9

Why is obesity a risk factor

Answer 9

Adipose tissue is a source of oestrogen

Adipose tissue contains aromatase, which is an enzyme that converts androgens such as testosterone into oestrogen

Question 10

Tamoxifen

Answer 10

SERM

Anti-oestrogenic effect on breast tissue, but an oestrogenic effect on the endometrium.

Question 11

Risk factors not related to unopposed oestrogen

Answer 11

T2DM

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

Question 12

Protective factors against endometrial cancer

Answer 12

Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking

Question 13

Presentation of endometrial cancer

Answer 13

Postmenopausal bleeding
Intermenstrual bleeding
Postcoital bleeding

Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count

Question 14

Referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer

Answer 14

Postmenopausal bleeding (more than 12 months after the last menstrual period)

Question 15

Referral for a transvaginal ultrasound

Answer 15

Women over 55 years with:

• Unexplained vaginal discharge
• Visible haematuria plus raised platelets, anaemia or elevated glucose levels

Question 16

Investigations for endometrial cancer

Answer 16

Bimanual and speculum examination

Transvaginal ultrasound - endometrial thickness (normal is less than 4mm post-menopause)

• Pipelle biopsy - highly sensitive for endometrial cancer, useful for excluding cancer
• Hysteroscopy with endometrial biopsy

Question 17

Pipelle biopsy

Answer 17

Done in an outpatient clinic

Speculum + insert a thin tube (pipelle) through the cervix into the uterus

Pipelle fills with a sample of endometrial tissue that can be examined for signs of endometrial hyperplasia or cancer.

Question 18

Management of endometrial cancer

Answer 18

Stage 1 and 2 - total abdominal hysterectomy with bilateral salpingo-oophorectomy

Other:

• radical hysterectomy - also removing the pelvic lymph nodes, surrounding tissues and top of the vagina
• Radiotherapy
• Chemotherapy
• Progesterone may be used as a hormonal treatment to slow the progression of the cancer

Question 19

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Answer 19

Removal of uterus, cervix and adnexa