Endometrial Cancer

Question 1

What is Endometrial cancer?

Answer 1

Cancer of lining of uterus

Question 2

What type of cancer is Endometrial cancer usually?

Answer 2

Adenocarcinoma (80%)

Question 3

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

Answer 3

Oestrogen-dependant cancer

Oestrogen stimulates the growth of endometrial cancer cells

Question 4

What is the precursor precancerous condition to Endometrial condition?

Answer 4

Endometrial hyperplasia

Question 5

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

Answer 5

5%

Question 6

What are the 2 types of Endometrial hyperplasia?

Answer 6

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

Question 7

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

Answer 7

Progestogens:

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

Question 8

What is the cause of Endometrial cancer?

Answer 8

Exposure to Unopposed oestrogen (aka oestrogen without progesterone)

Question 9

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

Answer 9

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

Question 10

How does PCOS increase risk of Endometrial cancer?

Answer 10

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

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

Question 11

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

Answer 11

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

Question 12

Why is Obesity a RF for Endometrial cancer?

Answer 12

Adipose tissue (fat) = source of oestrogen

Question 13

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

Answer 13

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

Question 14

Why is Tamoxifen a RF for Endometrial cancer?

Answer 14

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

Question 15

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

Answer 15

1. COCP
2. Mirena coil
3. Increased pregnancies
4. Smoking

Question 16

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

Answer 16

Postmenopausal bleeding

Question 17

What percentage of Endometrial cancer pt have PMB?

Answer 17

75-90%

Question 18

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

Answer 18

90%

Question 19

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

Answer 19

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

Question 20

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

Answer 20

Abd / pelvic masses

Question 21

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

Answer 21

1. Vulval / vaginal atrophy
2. Cervical lesions

Question 22

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

Answer 22

Size + axis of uterus b4 endometrial sampling

Question 23

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

Answer 23

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

Question 24

What is the FIRST line investigation for sus Endometrial cancer?

Answer 24

Transvaginal US

Question 25

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

Answer 25

Endometrial thickness of 5+ mm

Question 26

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

Answer 26

Endometrial biopsy

Question 27

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

Answer 27

Hysteroscopy

Question 28

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

Answer 28

CT / MRI for staging

Question 29

What staging system is used for Endometrial cancer?

Answer 29

International Federation of Gynaecology and Obstetrics (FIGO)

Question 30

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

Answer 30

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

Question 31

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

Answer 31

Total abdominal hysterectomy (TAH) with Bilateral salpingo-oophorectomy (BSO) (aka removing uterus, cervix and adnexa)

Question 32

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

Answer 32

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

Question 33

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

Answer 33

Progesterone