Endometrial cancer

Question 1

Two types of endometrial cancer and how they differ

Answer 1

1. Endometrioid and mucinous (80% of cancers)- oestrogen-related
2. Serous and clear-cell- not oestrogen related

Question 2

Risk factors for endometrial cancer (7)

Answer 2

Obesity
Late menopause/early menarche
PCOS
Nulliparity
HNPCC
Unopposed oestrogen
Tamoxifen

Question 3

What characteristic do HNPCC tumours show?

Answer 3

Microsatellite instability

Question 4

Typical presentation of endometrial carcinoma (2)

Answer 4

Post-menopausal bleeding

Menorrhagia in pre-menopausal women

Question 5

Investigation in suspected endometrial cancer (1)

Answer 5

TVUS- endometrial thickness

Question 6

Stage I disease

Answer 6

Confined to the body of the uterus

Question 7

Cancer confined to body of uterus and cervix

Answer 7

Stage II

Question 8

Stage III disease

Answer 8

advanced beyond the uterus but not beyond the pelvis (inc pelvic/para-aortic nodes)

Question 9

Management of early disease

Answer 9

Bilateral salpingo-oophorectomy and total hysterectomy

Question 10

Adjuvant therapy in advanced disease (3)

Answer 10

Radiotherapy- intracavity or external
High dose progestogens
Chemotherapy

Question 11

Management in frail patients unsuitable for surgery

Answer 11

High dose progestogens

Question 12

Leiomyoma is another word for…

Answer 12

Uterine fibroids

Question 13

What is the precursor lesion for type 1 (endometrioid) uterine cancer?

Answer 13

Atypical hyperplasia

Question 14

Why does obesity lead to higher levels of oestrogen?

Answer 14

Adipose tissue aromatises androgens into oestrogen. Also, sex-hormone binding globulin is lower in fat people

Question 15

What is the main risk factor for 80% of endometrial cancers?

Answer 15

Unopposed oestrogen

Question 16

What are fibroids/leiomyoma?

Answer 16

Benign smooth muscle tumours of the uterus

Question 17

Associations of fibroids

Answer 17

Commoner in afro-caribbean women;

Question 18

Why are fibroids rare before puberty and don’t tend to progress following menopause?

Answer 18

They develop in response to oestrogen

Question 19

Symptoms of fibroids (5)

Answer 19

May be asymptomatic; menorrhagia, lower abdominal pains, urinary symptoms, subfertility

Question 20

How are fibroids diagnosed?

Answer 20

Transvaginal ultrasound

Question 21

Medical management of fibroids

Answer 21

Symptomatic- COCP, GnRH agonists

Question 22

Surgical management of fibroids (3)

Answer 22

Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy

Question 23

How does the oral contraceptive pill affect risk for endometrial cancer?

Answer 23

Protective

Question 24

Why is the prognosis for endometrial cancer usually good?

Answer 24

Presents early