Endometrial Cancer

Question 1

What type of cancer is endometrial cancer usually?

Answer 1

Enometrioid adenocarcinoma

Question 2

How does endometrial cancer usually present?

Answer 2

• Postmenopausal vaginal bleeding

- pre menopausal recurrent metrorrhagia

Question 3

Who is mostly affected by endometrial cancer?

Answer 3

Post menopausal women

Question 4

Average age of endometrial cancer diagnosis?

Answer 4

Mean age =61

92% cases >50y (Diagnosed mostly 50-60y)

Question 5

What are the major risk factors for endometrial cancer?

Answer 5

• Obesity
• DM
• Hypertension

Question 6

What are additional (non major) RFx for endometrial cancer?

Answer 6

• Unopposed oestrogen
• Tamoxifen use for >5y
• Previous pelvic radiation therapy
• PHx or FHx breat or ovarian Ca
• FHx HNPCRC

Question 7

What is unopposed oestrogen associated with/ caused by?

Answer 7

• Obesity
• PCOS
• Nulliparity
• Late menopause
• Oestrogen producing tumours
• Anovulation
• Oestrogen therapy without progesterone

Question 8

Involvement of heredity in endometrial cancer?

Answer 8

• up to 10% cases

- 50% of these occur in families with Lynch (HNPCRC) syndrome

Question 9

What usually precedes endometrial cancer?

Answer 9

Endometrial hyperplasia

Question 10

What are the types of endometrial adenocarcinoma?

Answer 10

-Type I: more common; ER responsive, usually younger / obese / perimenopausal women. Usually low grade.
Type II: usually high grade; occur in older women. Up to 10% ECa.

Question 11

What are the mutations associated with Type I endometrial cancer?

Answer 11

Microsatellite instability + mutations:

• PTEN
• PIK3CA
• KRAS
• CTNNBI

Question 12

What are the mutations associated with Type II endometrial cancer?

Answer 12

-10-30% p53

Question 13

Examples of high grade histology demonstrated in Type II eCa?

Answer 13

• Serous

- Clear cell histolgy

Question 14

How many women with post menopausal bleeding have endometrial cancer?

Answer 14

1/3

Question 15

how is endometrial cancer diagnosed?

Answer 15

• Endometrial Bx

- Surgical staging

Question 16

What is suggestive of endometrial cancer?

Answer 16

• Post menopausal bleeding
• Abnormal bleeding in premenopausal women
• Pap showing endometrial cells in post menopausal woman
• Pap showing atypical endometrial cells in any woman

Question 17

What is pre treatment evaluation for endometrial cancer?

Answer 17

• FBE / UEC / LFTs
• CXR
• ECG
• Pelvic and abdo CT (?extrauterine / mets)

Question 18

When is pelvic / abdo CT conducted in endometrial cancer work up?

Answer 18

• Abdo mass or hepatomegaly on PEx
• Abnormal LFTs
• High risk histologic subtype (papillary serous carcinoma, clear cell carcinoma)

Question 19

How is staging conducted in endometrial cancer?

Answer 19

Surgically

• based on histologic differentiation (i-III)
• extent of spread (invasion depth, cervical involvement, extrauterine mets)
• included peritoneal fluid cytology, exploration, Bx suspicious lesions

Question 20

Prognosis endometrial cancer?

Answer 20

Prognosis is worse with higher-grade tumors, more extensive spread, and older patient age. Average 5-yr survival rates are
Stage I or II: 70 to 95%
Stage III or IV: 10 to 60%
Overall 63% 5y cancer free survival

Question 21

Treatment endometrial cancer?

Answer 21

• Total hysterectomy and bilateral salpingo-oophorectomy
• Pelvic and para-aortic lymphadenectomy for deep G1/2 and G3
• Pelvic radiation therapy +/- chemo for stage II or III
• Mulitmodal invididualsied for IV