Endometrial cancer

Question 1

What is the commonest histological subtype of endometrial cancer?

Answer 1

Adenocarcinoma

Question 2

What hormone stimulates the growth of endometrial cancer cells?

Answer 2

Oestrogen

Question 3

1) What is endometrial hyperplasia?
2) Endometrial hyperplasia can be treated by a specialist using progestogens - name 1 method to achieve this

Answer 3

1) Precancerous condition involving thickening of the endometrium
2) Intrauterine system (IUS) i.e. Mirena coil or
Continuous oral progestogens i.e. medroxyprogesterone or levonorgestrel

Question 4

Risk factors for endometrial cancer relate to the patient’s exposure to unopposed oestrogen (oestrogen without progesterone) - name 3 causes of this (in other words risk factors for endometrial cancer)

Answer 4

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

Question 5

1) How does PCOS increase the risk of endometrial cancer?
2) For endometrial protection, name a protective medication women with PCOS should have

Answer 5

1) Increased exposure to unopposed oestrogen. This is due to the fact that women with PCOS are less likely to ovulate and form a corpus luteum. Without developing a corpus luteum during the menstrual cycle, progesterone is not produced, and the endometrial lining has more exposure to unopposed oestrogen
2) Combined contraceptive pill, IUS, cyclical progestogens to induce a withdrawal bleed

Question 6

Why is obesity a risk factor for endometrial cancer?

Answer 6

Adipose tissue is a source of oestrogen (adipose tissue contains aromatase, which is an enzyme that converts androgens such as testosterone into oestrogen), and this is unopposed in women that aren’t ovulating

Question 7

Name an additional risk factors not related to unopposed oestrogen

Answer 7

• Type 2 diabetes
• Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome

Question 8

How does T2DM increase the risk of endometrial cancer?

Answer 8

In T2DM there’s increased production of insulin, and insulin stimulates the endometrial cells and increases the risk of endometrial hyperplasia and cancer. PCOS is also associated with insulin resistance and increased insulin production and insulin resistance further adds to the risk of endometrial cancer in women with PCOS

Question 9

Name 2 protective features of endometrial cancer

Answer 9

• Combined contraceptive pill
• IUS
• Increased pregnancies

Question 10

1) What is the main presenting symptom of endometrial cancer?
2) Name 2 other ways it can present

Answer 10

1) Post-menopausal vaginal bleeding
2) Postcoital bleeding, intermenstrual bleeding, unusually heavy menstrual bleeding, abnormal vaginal discharge, haematuria, anaemia, raised platelet count

Question 11

What is the referral criteria for a 2-week-wait urgent cancer referral for endometrial cancer?

Answer 11

Post-menopausal vaginal bleeding

Question 12

NICE recommends referral for a transvaginal ultrasound in women over 55 years that present with what (2)?

Answer 12

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

Question 13

What are the 3 main investigations for endometrial cancer?

Answer 13

• Transvaginal ultrasound for endometrial thickness (normal is less than 4mm post-menopause)
• Pipelle biopsy, which is highly sensitive for endometrial cancer making it useful for excluding cancer
• Hysteroscopy with endometrial biopsy

Question 14

What is the usual treatment for stage 1 or 2 of endometrial cancer?

Answer 14

Total abdominal hysterectomy with bilateral salpingo-oophorectomy, also known as a TAH and BSO (removal of uterus, cervix and adnexa)