Endometrial cancer

Question 1

Which demographic is endometrial cancer usually seen in?

Answer 1

Post-menopausal women mostly

25% are also before menopause

2nd most common gynae malignancy in the UK

Question 2

Risk factors for endometrial cancers? (5 groups)

Answer 2

Excess Oestrogen : Nulliparity, early menarche, late menopause, unopposed oestrogen (HRT)

Metabolic syndrome : obesity, DM, PCOS

Tamoxifen (oestrogen receptor agonist in endometrium)

Hereditary non-popyposis colorectal carcinoma

Granulosa cell tumour (produced oestrogen)

Question 3

Protective factors for endometrial cancer?

Answer 3

COCP, muliparity, smoking

Question 4

Clinical presentation of endometrial cancers?

Answer 4

Postmenopausal bleeding (usually light and becomes heavier)

Unexplained symptoms of vaginal discharge

Question 5

1st line Investigations for endometrial cancer?

Answer 5

1st line : TVUSS (thickened endometrium indicates endometrial cancer)

Can also do a pipelle biopsy

Question 6

What is seen on TVUSS for endometrial cancer?

Answer 6

1st line : TVUSS (thickened endometrium indicates endometrial cancer)

Question 7

What thickness of endometrium needs to be seen on TVUSS to do a hysteroscopy with biopsy?

Answer 7

1st line : TVUSS (thickened endometrium indicates endometrial cancer)

= >4mm

Question 8

What happens in a one stop clinic for post menopausal bleeding (suspected endometrial cancer)

Answer 8

A TVUSS with pipelle biopdy with or without outpatient hysteroscopy and histopathology.

If outpatient pipelle biopsy is not feasible or cannot be tolerated, do under anesthesia

Question 9

FIGO staging for endometrial cancer? (Stage I -> IV)

Answer 9

I = uterus
II = uterus + cervix
III = adnexa
IV = distant metastasis / bladder / bowel

Question 10

How is stage I endometrial cancer managed?

Answer 10

Stage 1 -> Total abdominal hysterectomy (uterus + cervix) and bilateral salpingo-oopherectomy

Question 11

How is stage II endometrial cancer managed?

Answer 11

Stage II : Radical hysterectomy and radiotherapy

Stage 1 -> Total abdominal hysterectomy (uterus + cervix) and bilateral salpingo-oopherectomy

Question 12

How is endometrial cancer managed in frail women who cannot have radiotherapy/surgeries?

Answer 12

Progestogen therapy (can be used to slow progression)

Question 13

What is endometrial hyperplasia and how can it be categorised?

Answer 13

Abnormal proliferation of endometrium

Typical

Atypical (more commonly develops into endometrial cancer)

Question 14

Which endometrial hyperplasiahas a higher chance to develop into endometrial cancer?

Answer 14

Atypical (more commonly develops into endometrial cancer)

Question 15

Typical endometrial hyperplasia 1st line management?

Answer 15

1st line LNG - IUS

2nd line - high dose progesterones
* treat for 6 months and review with TVUSS and endometrial biopsy every 6 months

Question 16

Typical endometrial hyperplasia 2nd line management?

Answer 16

1st line LNG - IUS

2nd line - high dose progesterones
* treat for 6 months and review with TVUSS and endometrial biopsy every 6 months

Question 17

Endometrial hyperplasia how often to scan?

Answer 17

1st line LNG - IUS

2nd line - high dose progesterones

• treat for 6 months and review with TVUSS and endometrial biopsy every 6 months

Question 18

How is Atypical Endometrial hyperplasia managed?

Answer 18

otal hysterectomy + bilateral salpingo-oopherectomy is post menopausal

If not hysterectomy -> Follow up every 3 months until two consecutive negative biopsies obtained

Question 19

Endometrial cancer prognosis?

Answer 19

Good - 5 year survival of 80%

Question 20

What is endometrial ablation?

Answer 20

Destroy endometrium deep enough to prevent regeneration

Question 21

What are the indications of endometrial ablation?

Answer 21

HMB for women with uterus no >10 weeks in size

Fibroids