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3. Y5 Zero to finals: O&G > Endometrial Cancer > Flashcards

Endometrial Cancer Flashcards

1
Q

What is Endometrial cancer?

A

Cancer of lining of uterus

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2
Q

What type of cancer is Endometrial cancer usually?

A

Adenocarcinoma (80%)

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3
Q

Endometrial cancer is an WHAT-dependant cancer? What does this mean?

A

Oestrogen-dependant cancer

Oestrogen stimulates the growth of endometrial cancer cells

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4
Q

What is the precursor precancerous condition to Endometrial condition?

A

Endometrial hyperplasia

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5
Q

What percentage of Endometrial hyperplasia goes on to become Endometrial cancer?

A

5%

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6
Q

What are the 2 types of Endometrial hyperplasia?

A
  1. Hyperplasia without atypia
  2. Atypical hyperplasia (more likely to progress to cancer)
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7
Q

What is the Tx for Endometrial hyperplasia? (2 things)

A

Progestogens:

  1. Intrauterine system (e.g Mirena coil)
  2. Continuous oral progestogens (e.g levonorgestrel)
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8
Q

What is the cause of Endometrial cancer?

A

Exposure to Unopposed oestrogen (aka oestrogen without progesterone)

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9
Q

What are the RF for Endometrial cancer? (7 things)

A
  1. Age
  2. Early menarche / Late menopause
  3. Oestrogen only HRT
  4. Nuliparity
  5. Obesity
  6. PCOS
  7. Tamoxifen
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10
Q

How does PCOS increase risk of Endometrial cancer?

A

Usually: Ovulation –> Corpus luteum formed –> CL produces Progesterone (which opposes oestrogen)

In PCOS: Anovulation = so all this doesn’t happen

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11
Q

How do you protect the Endometrium in women with PCOS? (3 things)

A
  1. COCP
  2. Intrauterine system (e.g Mirena coil)
  3. Cyclical progestogens (to induce a withdrawal bleed)
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12
Q

Why is Obesity a RF for Endometrial cancer?

A

Adipose tissue (fat) = source of oestrogen

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13
Q

How does Adipose tissue increase Oestrogen in body? (2 things)

A
  1. Adipose tissue contains Aromatase
  2. Aromatase converts androgens (aka testosterone) –> Oestrogen
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14
Q

Why is Tamoxifen a RF for Endometrial cancer?

A

Has oestrogenic effect on Endometrial (while has anti-oestrogenic effect on breast tissue)

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15
Q

What are the Protective Factors vs Endometrial Cancer? (4 things)

A
  1. COCP
  2. Mirena coil
  3. Increased pregnancies
  4. Smoking
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16
Q

What is the main CF of Endometrial cancer that means it is Endometrial cancer unless proven otherwise?

A

Postmenopausal bleeding

17
Q

What percentage of Endometrial cancer pt have PMB?

A

75-90%

18
Q

What percentage of women w PMB do NOT have Endometrial cancer?

A

90%

19
Q

What other CF can Endometrial cancer present with? (4 things)

A
  1. Clear / white vaginal discharge
  2. Abn cervical smear
  3. Abd pain (advanced / metastatic)
  4. Weight loss (advanced / metastatic)
20
Q

What are you checking for in an Abd examination of sus Endometrial cancer?

A

Abd / pelvic masses

21
Q

What are you checking for in a Speculum examination of sus Endometrial cancer? (2 things)

A
  1. Vulval / vaginal atrophy
  2. Cervical lesions
22
Q

What are you assessing in an Abd examination of sus Endometrial cancer?

A

Size + axis of uterus b4 endometrial sampling

23
Q

What are some DDx that present similarly to Endometrial cancer (aka PMB)? (3 things)

A
  1. Vulval atrophy / pre-malignant vulval conditions
  2. Cervical polyps / cancer
  3. Endometrial hyperplasia / polyps / atrophy
24
Q

What is the FIRST line investigation for sus Endometrial cancer?

A

Transvaginal US

25
Q

What do the majority (96%) of Endometrial cancer pt show on the Transvaginal US?

A

Endometrial thickness of 5+ mm

26
Q

What investigation should you do if you see Endometrial thickness of 4+ mm in Transvaginal US?

A

Endometrial biopsy

27
Q

What other investigation can you do for sus Endometrial cancer apart from TUS and biopsy?

A

Hysteroscopy

28
Q

Once Endometrial cancer is confirmed, what investigation should you do next and why?

A

CT / MRI for staging

29
Q

What staging system is used for Endometrial cancer?

A

International Federation of Gynaecology and Obstetrics (FIGO)

30
Q

What are the stages of Endometrial cancer in the FIGO system? (4 stages)

A
  1. Stage 1: Confined to uterus
  2. Stage 2: Invades cervix
  3. Stage 3: Invades ovaries / fallopian tubes / vagina / lymph nodes
  4. Stage 4: Invades bladder / rectum / beyond pelvis
31
Q

What are the Tx options for Stage 1 and 2 Endometrial cancer?

A

Total abdominal hysterectomy (TAH) with Bilateral salpingo-oophorectomy (BSO)

(aka removing uterus, cervix and adnexa)

32
Q

What are the Tx options for Stage 1 and 2 Endometrial cancer? (2 things)

A
  1. Maximal de-bulking surgery (if possible)
  2. Chemo + Radio
33
Q

What can be given to Endometrial cancer patients to slow progression of cancer?

A

Progesterone

3. Y5 Zero to finals: O&G (27 decks)

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