Endometrial Cancer

Question 1

what are the risk factors for endometrial cancer?

Answer 1

> high circulating oestrogen levels
 - late menopause
 - early menarche
 - poly cystic ovarian syndrome
 - unopposed E2 therapy (tamoxifen)
 - obesity
> post menopausal women
> atypical endometrial hyperplasia
> familial cancer syndromes (HNPCC and lynch type 2)

Question 2

what is the differential diagnosis in post menopausal bleeding (abnormal vaginal bleeding)?

Answer 2

> ENDOMETRIAL CANCER
> atrophic vaginitis
> perimenopausal bleeding
> endometrial or cervical polyps
> cancer in the bladder, cervix, vulva
> hormone replacement therapy

Question 3

describe type 1 endometrial cancer?

Answer 3

> commonest
endometrial adenocarcinoma
atypical precursor of hyperplasia
unopposed oestrogen

Question 4

describe type 2 endometrial cancer?

Answer 4

> older ladies
uterine serous and clear cell carcinoma
serous intraepithelial carcinoma precursor
high grade: worse prognosis and more aggressive

Question 5

how is endometrial cancer investigated?

Answer 5

> transvaginal ultrasound
- measure the endometrial thickness
- look at endometrial contour
biopsy if more than 4mm with hysteroscopy the histology will give diagnosis

Question 6

how is endometrial cancer staged?

Answer 6

with an MRI to check cervical involvement, depth of myometrial invasion and lymph node involvement

Question 7

describe stage one endometrial cancer

Answer 7

A. inner half of the myometrium

B. outer half of the myometrium

Question 8

describe stage 2 endometrial cancer

Answer 8

invasion of the cervix

Question 9

describe stage 3 endometrial cancer

Answer 9

A. serosa adenexa
B. vagina parametrium
C. pelvic paraortic nodes

Question 10

describe stage 4 endometrial cancer

Answer 10

> intra-abdominal
inguinal nodes
bowel
bladder

Question 11

how is endometrial cancer managed?

Answer 11

> early stage = surgery
high risk histology = chemotherapy
advanced stage = external beam radiotherapy
palliation = progesterone