Endometrial Cancer

Question 1

What are risk factors?

Answer 1

Excess oestrogen
- nulliparity
- early menarche
- late menopause
- unopposed oestrogen

Obesity
DM
PCOS
Tamoxifen
HNPCC

Protective Factors
- Multiparity
- COCP
- Smoking

Question 2

What are the features?

Answer 2

Postmenopausal bleeding

Pre-menopausal
- menorrhagia, intermenstrual bleeding
- pain is rare
- sometimes vaginal discharge

Question 3

What are the investigations?

Answer 3

If >55 and post menopausal bleeding referred 2 week wait
Transvaginal US- normal endometrial thickness <4mm high negative value

Hysteroscopy with endometrial biopsy

Consider direct access US in anyone >55 and either
- unexplained vaginal discharge AND 1st presentation or thrombocytosis, report haematuria
-visible haematuria and Anaemia or thrombocytosis or hyperglycaemia

Question 4

What is the maangement?

Answer 4

Surgery
Localised disease- TAH with bilateral saplingo-oopherectomy

Patients with high risk disease may require post op radiotherapy

Progesterone therapy considered in frail women not suitable for surgery.