Endometrial Cancer

Question 1

Describe epidemiology of endometrial cancer

Answer 1

Endometrial cancer is classically seen in post-menopausal women but around 25% of cases occur before the menopause.

It usually carries a good prognosis due to early detection.

Question 2

What are RFs of endometrial cancer?

Answer 2

1. Excess oestrogen
   - Nulliparity
   - Early menarche
   - Late menopause
   - Unopposed oestrogen (addition of progesterone to oestrogen in HRT reduces this risk)
2. Metabolic syndrome - obesity, diabetes mellitus, PCOS
3. Tamoxifen
4. Hereditary non-polyposis colorectal carcinoma

Question 3

What are protective factors for endometrial cancer?

Answer 3

multiparity
combined oral contraceptive pill
smoking

Question 4

What are the features of endometrial cancer?

Answer 4

Postmenopausal bleeding - usually slight and intermittent before becoming heavier

premenopausal women may develop menorrhagia or intermenstrual bleeding
pain is not common and typically signifies extensive disease
vaginal discharge is unusual

Question 5

How is endometrial cancer investigated?

Answer 5

Women >55 with postmenopausal bleeding should be referred via suspected cancer pathway
1st line: TVUS - normal endometrial thickness (< 4 mm) has a high negative predictive value
hysteroscopy with endometrial biopsy

Question 6

How is endometrial cancer managed?

Answer 6

Mainstay of management is surgery

Localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy
Patients with high-risk disease may have postoperative radiotherapy
Progestogen therapy is sometimes used in frail elderly women not considered suitable for surgery