Endometrial Cancer Flashcards
What is the most common type of endometrial cancer
80% = adenocarcinoma
What hormone is implicated in endometrial cancer?
Oestrogen-dependent cancer - oestrogen stimulates the growth of endometrial cancer cells
What is the precancerous condition of endometrial cancer?
Endometrial hyperplasia = involves the thickening of the endometrium
What happens to most cases of endometrial hyperplasia?
Returns to normal over time
How often does endometrial hyperplasia go onto be endometrial cancer?
<5%
What are the 2 types of endometrial cancer?
- hyperplasia without atypia
- atypical hyperplasia
How is endometrial hyperplasia treated?
By a specialist using progesterone with either:
- intrauterine system (eg Mirena coil)
- continuous oral progestogens (eg medroxyprogesterone or levonorgestrel)
What is the basis for some of the risk factors for endometrial cancer?
Exposure to unopposed Estrogen
- refers to estrogen without progesterone
- stimulates the endometrial cells and increases the risk of endometrial hyperplasia and cancer
What are some risk factors for endometrial cancer due to unopposed estrogen exposure?
- increased age
- earlier onset of menstruation
- late menopause
- oestrogen only hormone replacement therapy
- no or fewer pregnancies
- obesity
- PCOS (lack of ovulation means no progesterone from the corpus luteum)
- tamoxifen
What should women with PCOS have for endometrial protection?
One of the following:
* combined contraceptive pill
* intrauterine system (eg Mirena coil)
* cyclical progestogens to induce a withdrawal bleed
How does obesity impact unopposed estrogen and thereby increase the risk of endometrial cancer?
Adipose tissue is a source of oestrogen - primary source in post menopausal women
Adipose tissue contains aromatase enzyme that converts androgens like testosterone into oestrogen
How does tamoxifen impact unopposed estrogen production?
- anti-oestrogenic effect on breast tissue
- oestrogenic effecet on endometrium
What are some additional risk factors for endometrial cancer not related to unopposed oestrogen?
- type 2 diabetes (increased insulin = stimulate endometrial cells)
- HNPCC or Lynch syndrome
What are some protective factors for endometrial cancer?
- COCP
- Mirena coil
- increased pregnancies
- smoking (in post menopausal women by being anti-oestrogenic)
How does endometrial cancer present?
- postmenopausal bleeding
- postcoital bleeding
- intermenstrual bleeding
- unusually heavy menstrual bleeding
- abnormal vaginal discharge
- Haematuria
- anaemia
- raised platelet count
What are the referral criteria for endometrial cancer?
Referral for a 2 week wait = PMB
TVUS in women over 55 with unexplained vaginal discharge or visible Haematuria plus raised platelets, anaemia or elevated glucose levels
What is PMB?
Bleeding more than 12 months after the LMP
What 3 investigations are used for the diagnosis/exclusion of endometrial cancer?
- TVUS for endometrial thickness (normal <4mm post menopausal)
- pipelle biopsy (highly sensitive = useful for excluding) (outpatient)
- hysteroscopy with endometrial biopsy
How is endometrial cancer staged?
FIGO
Stage 1 = confined to uterus
Stage 2 = invades cervix
Stage 3 = invades ovaries, Fallopian tubes, vagina or lymph nodes
Stage 4 = invades bladder, rectum or beyond pelvis
What is the usual treatment for stage 1 & 2 endometrial cancer?
Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH and BSO)
What other treatments are available for endometrial cancer?
- radical hysterectomy (includes pelvic lymph nodes, surrounding tissues and top of vagina)
- radiotherapy
- chemotherapy
- progesterone (slow progression of cancer)
