endometrial cancer Flashcards
when is this suspected
postmenopausal bleeding
what type of cancer/ caused by
adenocarcinoma- related to excessive exposure to oestrogen unopposed by progesterone
risk factors
obesity, unopposed oestrogen treatment, functioning ovarian tumour, FH breast, ovarian, colon cancer; nulliparity; late menopause; DM; tamoxifen, tibolone; pelvic irradiation, polycystic ovaries
presentation
postmenopausal bleeding. sometimes seen on smear. uterine ultrasound.
diagnosis
uteirne sampling or curettage. all parts of uterus must be sampled
what does hysteroscopy require
dilatation of the os- misoprostol can be used
where do most tumours start
fundus, spread to uterine muscle, cervix and or peritoneum
where can they metastasise to
vagina, ovary, pelvic lymph nodes
staging
1- body of uterus only, 2- body and cervix, 3- advances beyond uterus not outside pelvis, 4- extends outside pelvis
treatment
stage 1 and 2- total hysterectomy with bilat salpingo-oopherectomy; radiotherapy
treatment advanced disease
radiotherapy +- high dose progestogens- medroxyprogesterone acetate- shrinks the tumour
recurrent disease treatment
progestogens, surgery, radiotherapy
when is a sample required (mm thickness on ultrasound)
> 5mm
when is endometrial sampling not indicated
when is endometrial sampling less useful
menorrhagia in women with regular cycles as pathology less common
