Endometrial Cancer Flashcards
How common is endometrial cancer, relative to other cancers?
5th most common cancer in women in the UK
Who does endometrial cancer largely affect?
Post-menopausal women, particularly those aged 60-79 years
What % of female cancers are endometrial cancer?
5%
What is the most common cancer of the uterus?
Endometrial cancer
What type of cancers are the majority of endometrial cancers?
Afrnocarcinomas
What are the different types of endometrial adenocarcinoma?
Endometrioid
Papillary serous
Clear cell
What is the most common type of endometrial adenocarcinoma?
Endometrioid
What is a rarer form of endometrial cancer?
Carcinosarcoma of the uterus
How does carcinosarcoma of the uterus differ from endometrial adenocarcinoma?
It behaves in a more aggressive manner
What hormonal factors are associated with an increased risk of endometrial cancer?
A high level of oestrogen unopposed by progesterone
What is the result of a high level of unopposed oestrogen increasing the risk of endometrial cancer?
Factors that result in excess oestrogen or low progesterone increase a woman’s risk of endometrial cancer
What are the risk factors for endometrial cancer?
- Hormonal factors
- Hypertension
- Diabetes mellitus
- Lynch type II syndrome
- Endometrial hyperplasia with atypia
Is endometrial hyperplasia with atypia a benign or malignant condition?
Benign
What factors are protective against endometrial cancer?
- History of pregnancy
- COCP use
Does endometrial cancer tend to present early or late?
Early
What are the early symptoms of endometrial cancer?
Inter-menstrual or post-menopausal bleeding, or recent-onset menorrhagia
Which women with post-menopausal bleeding should be investigated for endometrial cancer?
All over 45
What are some less common symptoms of endometrial cancer?
- Lower abdominal discomfort
- Vaginal discharge
- Dyspareunia
Can bimanual palpation and speculum examination be normal in early endometrial cancer?
Yes
What symptoms might advanced endometrial cancer cause?
- Urinary frequency
- Fatigue
- Loss of appetite
- Back pain
- Constipation
How does spread of endometrial cancer usually occur?
Directly through the myometrium to the cervix and vagina
How do metastases occur in endometrial cancer?
- Lymphatic system
- Haematogenous spread
When does haematogenous spread occur in endometrial cancer?
Usually late
What is the result of haematogenous spread occurring late in endometrial cancer?
Widespread metastasis at presentation is unusual
What can the risk factors for endometrial cancer be divided into?
- Endogenous or exogenous
- High oestrogen levels or low progesterone levels
Give 2 endogenous causes of high oestrogen levels
- Obesity
- Ovarian granulosa cell tumour
Give 2 exogenous causes of high oestrogen levels
- Oestrogen-only HRT
- Tamoxifen
Give 4 endogenous causes of low progesterone levels
- Polycystic ovarian syndrome
- Nulliparity
- Early menarche
- Late menopause
What staging system is used for endometrial cancer?
FIGO
What is 1a endometrial cancer?
Disease in the body of the uterus, with invasion of <50% myometrium
What is 1b endometrial cancer?
Disease in the body of the uterus, with invasion of >50% of the myometrium
What is stage 2 endometrial cancer?
Disease in body of uterus and cervix
What is stage 3a endometrial cancer?
Disease advanced within the pelvis, with involvement of the ovaries
What is stage 3b endometrial cancer?
Disease advanced within the pelvis, with involvement of the vagina and parametrium
What is stage 3c endometrial cancer?
Disease advanced within the pelvis, with involvement of the local lymph nodes
What is stage 4a endometrial cancer?
Disease spread to outside the pelvis, with involvement of bowel or bladder
What is stage 4b endometrial cancer?
Disease spread outside the pelvis, with involvement of more distant organs
What initial investigation is used in endometrial cancer?
Transvaginal ultrasound
What is the purpose of the transvaginal ultrasound in the initial investigation of endometrial cancer?
Assess endometrial thickness
What endometrial thickness is suggestive of endometrial cancer in post-menopausal women?
> 4mm
Is an endometrial thickness of >4mm in post-menopausal women diagnostic of endometrial cancer?
No
Is endometrial thickness a reliable indicator of endometrial cancer in pre-menopausal women?
No
Why is endometrial thickness not a reliable indicator of endometrial cancer in pre-menopausal women?
Because endometrial thickness varies during the menstrual cycle
What investigation is required to confirm a diagnosis of endometrial cancer?
Endometrial biopsy
What biopsy techniques can be used to obtain an endometrial biopsy?
- Pipelle
- Hysteroscopy
- Dilation and curettage
What kind of endometrial biopsy cannot be used to diagnose endometrial cancer?
Pipelle
Why can a pipelle biopsy not be used to diagnose endometrial cancer?
Because it does not assess if the basement membrane is breached
What might be looked for on the blood sample in endometrial cancer?
CA125
What is CA125 good for in endometrial cancer?
Disease monitoring
What is the limitation of CA125 in endometrial cancer?
It is not sensitive or specific for endometrial cancer
What investigations should be done if endometrial cancer is confirmed?
- Chest x-ray
- CT
- Pelvic MRI
What is the purpose of a CXR in endometrial cancer?
Check for pulmonary metastasis
What is the purpose of a pelvic MRI scan in endometrial cancer?
Can assess the size and extent of invasion of the tumour into the cervix and myometrium
What is the purpose of an examination under anaesthesia in endometrial cancer?
Assess size and mobility of uterus, and any involvement of vagina, cervix, bladder, or rectum
Why might advanced endometrial cancer present with renal impairment?
Because it can cause hydronephrosis
How is endometrial cancer staged?
Using the FIGO staging system
What is the FIGO staging system based on?
Surgical and histological findings
What is the result of the FIGO staging system for endometrial cancer being based on surgical features?
Accurate staging requires an operative procedure
What does the treatment of endometrial cancer depend on?
- The stage and grade of the cancer
- The general health of the woman
What is usually sufficient in the treatment of women with stage 1a endometrial cancer?
Surgery with total abdominal hysterectomy and bilateral salpingo-oophrectomy
When is the likelihood of lymph node involvement low in stage 1a endometrial cancers?
When the tumour is confined to the inner 1/3 of the myometrium
How common is early stage endometrial cancer, compared to other stages?
The majority of women with endometrial cancer have early stage disease
When is adjuvant pelvic radiotherapy given alongside surgery in endometrial cancer?
In women with stage 1b or 2 disease, or for high-grade cancers
What is the purpose of adjuvant pelvic radiotherapy in endometrial cancer?
It reduces the rate of local recurrence
When might radiotherapy be used as the primary treatment for endometrial cancer?
- In women unfit to undergo surgery
- In women with locally advanced disease (stage 3 and 4a)
What treatment is used for women with recurrent endometrial cancer?
Hormonal therapy using progesterones
What is the purpose of hormonal therapy using progesterones in recurrent endometrial cancer?
It can be used to slow the growth of the cancer
What do the best response rates to endocrine therapy in recurrent endometrial cancer correlate with?
- Well-differentiated histology
- Long disease-free interval following primary treatment
- Increased expression of progesterone receptors
What is the response rate to progesterone therapy in endometrial cancer?
25%
What is the progression-free survival rate of progesterone therapy in endometrial cancer?
4 months
What chemotherapy agents may be used in endometrial cancer?
- Carboplatin and paclitaxel
- Cisplatin and doxorubicin
What is the purpose of chemotherapy in endometrial cancer?
It can improve disease control and symptoms in patients with current disease
What is the limitation of chemotherapy in endometrial cancer?
It’s impact on survival is limited
Is there any benefit of chemotherapy given in an adjuvant therapy in endometrial cancer?
Limited
Is there any benefit in combining chemotherapy with hormonal therapy?
No
What short-term side effects may arise from pelvic radiotherapy?
- Diarrhoea
- Cystitis
- Nausea
- Tiredness
What are the longer-term side effects of pelvic radiotherapy?
- Early menopause
- Vaginal dryness
- Urinary frequency
- Persistent diarrhoea
How does pelvic radiotherapy cause urinary frequency?
Due to bladder wall fibrosis
What side effects are associated with progesterone therapy?
- Water retention
- Breast tenderness
- Nausea
- Tiredness
How does the prognosis of endometrial cancer differ from other gynaecological cancers?
It has the best prognosis of all the gynaecological cancers
What are the poor prognostic factors of endometrial cancer?
- Older age
- Advanced stage
- High-grade tumours
- Adenosquamous histology
At what location of disease is recurrent endometrial cancer most common?
The vaginal vault
When does recurrent endometrial cancer often present?
Within 2-3 years of the primary treatment
What is the 5 year survival of stage 1 endometrial cancer?
80%
What is the 5 year survival of stage 2 endometrial cancer?
70-80%
What is the 5 year survival or stage 3 endometrial cancer?
40-50%
What is the 5 year survival of stage 4 endometrial cancer?
20-30%
