Endometrial cancer 2B

Question 1

it is due to what type of cancerous cell

Answer 1

• Due to adenomacarcinoma starting in the fundus

Question 2

what factors have been linked with an increase in incidence and poor outcome

Answer 2

• Overweight and obesity are associated with an increase in incidence and poor outcome

Question 3

presentation?

Answer 3

post-menopausal vaginal bleeding which gets heavier and often have surgically curable disease

Question 4

it is caused by imbalance in what female gonads

Answer 4

• Caused by oestrogen and no progesterone

Question 5

what are the premalignant states

Answer 5

• Premalignant states include endometrial hyperplasia and polyps

Question 6

what is seen on examination

Answer 6

• O/E: abdominal mass may be seen if extra uterine but will typically have a normal pelvic exam

Question 7

what is a primary prevention method

Answer 7

• Can sometimes be picked up by smear

Question 8

what are the risk factors

Answer 8

• RF: **remember things that increase oestrogen levels and there is no homeostatic regulation with progesterone
 oestrogen only HRT
 oestrogen receptor tamoxifen (it can be an antagonist in the breast tissue but agonist in the endometrium)
 Tibolone: used for short term treatment of oestrogen deficiency and can also be used as a osteoporosis prophylaxis in women with osteoporosis and at ↑risk of fractures
 PCOS
 Pelvic irradiation
 Chronic disease: diabetes, HTN, hypothyroidism
 FH: Breast, ovarian and colorectal Ca
 Age >50 yrs
 Smoking may ↓ risk

Question 9

what are the ddx

Answer 9

endometrial hyperplasia, endometrial polyp, submucous fibroid, vaginal atrophy, vival lichen sclerosus

Question 10

investigations?

Answer 10

 TVUS
 If endometrial thickness is >4mm on TVUS or >16mm and premenopausal do a pipelle biopsy (plastic cannula with plunger)
 Pap smear
 Hysteroscopy and biopsy (curettage)= more sensitive and can rule out and treat benign causes such as polyps
 Blood : FBC for anaemia and CA125 as a tumour marker

Question 11

• FIGO staging

Answer 11

(U CABBA)
 Stage 0 = in uterus
 Stage 1= Cervix
 STAGE 2= Adnexa, vagina or pelvic or para-aortic nodes
 Stage 3= bowel, bladder, distant metastasis; in abdominal or inguinal nodes

Question 12

management ?

Answer 12

 HSO= open bilateral hystero-salpingo-oophorectomy (HSO)
 In stage 2= pelvic lymph node clearance
 Adjuvant radiotherapy (may be needed for stage 1-2)
 In stage 3-4= adjuvant chemotherapy (Paclitaxel + cisplatin + doxorubicin)
 Palliative chemo and radiotherapy in unresectable disease