Endometrial Cancer Flashcards
What is endometrial cancer
Epithelial malignancy of the uterine corpus mucosa, usually adenocarcinoma
Aetiology of endometrial cancer
Unopposed endogenous/exogenous oestrogenic stimulation → Endometrial hyperplasia
Risk factors for endometrial cancer
Post-menopausal
Obesity (adipose tissue)
Nulliparity
Early menarche
Late menopause
Diabetes mellitus
Tamoxifen use
PCOS
HNPCC/Lynch
Symptoms of endometrial cancer
Post-menopausal bleeding (>12 months after menstruation has stopped) OR change in intermenstrual bleeding
Changes in vaginal discharge
Pelvic swelling/back pain/dyspareunia/haematuria
Abdominal/pelvic pain
Weight loss
Signs of endometrial cancer
- Weight, Height, BM
- Observations
○ HR, RR, sats, temperature, BP - Pelvic examination
○ gives an idea of the uterine size and also evaluates for adnexal mass.
○ Uterine mass
○ Fixed uterus - Lymph node examination
○ Enlarged lymph nodes
- Observations
Differentials for endometrial cancer
Endometrial hyperplasia
Endometrial polyps
Endometriosis
Cervical cancer
Investigations for endometrial cancer
(after 2ww referral)
First line: TV USS
Gold: Hysteroscopy with endometrial biopsy
Bedside:
Urine dipstick - if haematuria ?infection
BM - indicates direct access USS
Bloods:
FBC - anaemia or thrombocytosis indicates direct access USS
Ca-125 - rule out ovarian cancer
Scans
TV USS - Endometrial thickness >4mm
CT/MRI uterus/pelvis/abdomen - check for mets
Other
Hysteroscopy with endometrial biopsy - if thickness >5mm on US
Management for endometrial cancer
Postmenopausal bleeding → refer using the 2ww cancer pathway
Management depends on stage of disease
Generally:
Total hysterectomy with bilateral salpingo-oophorectomy
± radiotherapy (vaginal brachytherapy, external bean radiotherapy)
± adjuvant chemotherapy (paclitaxel + carboplatin)
What are the types of endometrial cancer
Type 1: low grade endometrioid cancers, usually oestrogen-sensitive, associated with obesity, less aggressive
Type 2: High grade endometrioid, clear cell, serous, or carcinosarcoma cancers, not oestrogen-sensitive, not associated with obesity, more aggressive
Prognosis for endometrial cancer
Generally good prognosis, especially if caught in early stages (70-75%)
5-year survival is 95% for localised disease
with mets → 17.3%
85% of cases will recur in the first 2 years
What is the management for the following situations of endometrial cancer: (1) cervical involvement (2) recurrent or incurable (3) preserving fertility
Cervical involvement → radical hysterectomy
Recurrent or incurable → supportive, salvage radiotherapy, palliative chemo, hormonal therapy with progestin
preserving fertility → aggressive monitoring, hysteroscopy with sampling every 3-6 months
