Endometrial cancer Flashcards
What are 3 cancers that can arise in the uterus?
Endometrial (most)
Sarcoma
Leiomyosarcoma
What is the risk of endometrial hyperplasia without atypia progressing to endometrial cancer? How should these patients be managed?
<5% over 20y
Majority regress spontaneously
LNG IUS/ Progesterone
6 monthly repeat EB
x 2 -ve: discharge (high risk do yearly EB)
Still bleeding/ no regression: TLH/ TAH +/- BSO
What is the risk of endometrial hyperplasia with atypia progressing? How should these patients be managed?
23-48%
Offer TLH/ TAH +/- BSO
If wanting to conceive, regression should be achieved on at least 1 EB before attempting
What is endometrial hyperplasia?
proliferation of endometrial glands resulting in a greater gland-to-stroma ratio than in normal endometrium.
a/w progression to adenocarcinoma
What stimulates endometrial hyperplasia?
Oestrogen when unopposed by progesterone, binding to oestrogen receptors in nuclei of endometrial cells
How does high BMI contribute to endometrial hyperplasia?
Excess peripheral conversion of androgens to oestrogen
What are 7 risk factors for endometrial cancer?
Metabolic syndrome:
Overweight + obesity
PCOS (anovulation)
DM/ Insulin resistance
Excess oestrogen:
Nulliparity
Early menarche
Late menopause
Unopposed oestrogen HRT
Age >50 years
Endometrial hyperplasia
Tamoxifen
FH of endometrial/ breast/ ovarian cancer
Hereditary non-polyposis colorectal cancer
Give 3 protective factors against endometrial cancer
Multiparity
COCP
Smoking
Summarise the epidemiology of endometrial cancer.
Most common gynae tumour in developed world.
6th most common cancer overall in women.
What is the classic symptom of endometrial cancer?
PMB
Usually slight + intermittent before getting heavier
How may a pre-menopausal woman present with endometrial cancer?
Menorrhagia
IMB
What does endometrial cancer RARELY present with?
Pain- signifies extensive disease
What does endometrial cancer present with on physical examination?
Uterine mass, fixed uterus, or adnexal mass indicating extra-uterine disease
What are the investigations for endometrial cancer?
TVUSS
Hysteroscopy with endometrial biopsy + histopathology
MRI/ CTCAP with contrast
FBC: anaemia/ coagulation disorders
Discussion in MDT
What action needs to be taken depending on TVUSS findings?
Postmenopausal endometrial thickness
>4mm: Endometrial biopsy
<4mm: biopsy not routine, consider for persistent/ recurrent Sx
Give 3 indications for endometrial biopsy in postmenopausal women
Endometrial lining >4mm
Endometrial lining cannot be adequately visualised
Endometrial lining <4mm but clinical features of cancer persist
Give 3 indications for endometrial biopsy in premenopausal women
> 45y
Persistent/ recurrent AUB despite Tx
Hx of unopposed oestrogen exposure
What investigations would be performed to exclude differentials in endometrial cancer?
TVUSS: endometriosis, endometrial polyp
EB: endometrial hyperplasia
Smear: cervical cancer
What therapy may be used for frail elderly women with endometrial cancer?
Progestogen therapy
What staging system is used for endometrial cancer?
FIGO
I: limited to body of uterus
II: cervical involvement
III: spread within pelvis
IV: involvement of rectum/ bladder/ distant mets
How does treatment vary for each stage of endometrial cancer?
I: TAH +BSO or LNG-IUS
II: Radical hysterectomy + LN assessment
III: max. debulking surgery + chemo + radio
IV: max. debulking surgery / palliative approach- radio/ progesterone
Summarise the prognosis for patients with endometrial cancer.
5y survival rate for endometrial cancer by stage at dx is:
- Localised (confined to uterus): 95%
- Regional (disease spread regional LN): 69.4%
- Distant (metastatic disease): 17.3%
- Unstaged: 53.2%.
Identify 7 possible complications of endometrial cancer and its management.
Menopausal Sx: if pre-menopausal BSO
Bladder instability following surgery: pain, incontinence
Vaginal stenosis, atrophy, + fibrosis following radiotherapy
Long-term sexual dysfunction following tx
Local or distant spread
Lymphoedema
Toxicity a/w chemotherapy
