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Z - Cancer Care Old > Endometrial Cancer > Flashcards

Endometrial Cancer Flashcards

1
Q

How common is endometrial cancer, relative to other cancers?

A

5th most common cancer in women in the UK

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2
Q

Who does endometrial cancer largely affect?

A

Post-menopausal women, particularly those aged 60-79 years

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3
Q

What % of female cancers are endometrial cancer?

A

5%

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4
Q

What is the most common cancer of the uterus?

A

Endometrial cancer

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5
Q

What type of cancers are the majority of endometrial cancers?

A

Afrnocarcinomas

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6
Q

What are the different types of endometrial adenocarcinoma?

A

Endometrioid
Papillary serous
Clear cell

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7
Q

What is the most common type of endometrial adenocarcinoma?

A

Endometrioid

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8
Q

What is a rarer form of endometrial cancer?

A

Carcinosarcoma of the uterus

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9
Q

How does carcinosarcoma of the uterus differ from endometrial adenocarcinoma?

A

It behaves in a more aggressive manner

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10
Q

What hormonal factors are associated with an increased risk of endometrial cancer?

A

A high level of oestrogen unopposed by progesterone

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11
Q

What is the result of a high level of unopposed oestrogen increasing the risk of endometrial cancer?

A

Factors that result in excess oestrogen or low progesterone increase a woman’s risk of endometrial cancer

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12
Q

What are the risk factors for endometrial cancer?

A
  • Hormonal factors
  • Hypertension
  • Diabetes mellitus
  • Lynch type II syndrome
  • Endometrial hyperplasia with atypia
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13
Q

Is endometrial hyperplasia with atypia a benign or malignant condition?

A

Benign

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14
Q

What factors are protective against endometrial cancer?

A
  • History of pregnancy

- COCP use

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15
Q

Does endometrial cancer tend to present early or late?

A

Early

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16
Q

What are the early symptoms of endometrial cancer?

A

Inter-menstrual or post-menopausal bleeding, or recent-onset menorrhagia

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17
Q

Which women with post-menopausal bleeding should be investigated for endometrial cancer?

A

All over 45

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18
Q

What are some less common symptoms of endometrial cancer?

A
  • Lower abdominal discomfort
  • Vaginal discharge
  • Dyspareunia
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19
Q

Can bimanual palpation and speculum examination be normal in early endometrial cancer?

A

Yes

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20
Q

What symptoms might advanced endometrial cancer cause?

A
  • Urinary frequency
  • Fatigue
  • Loss of appetite
  • Back pain
  • Constipation
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21
Q

How does spread of endometrial cancer usually occur?

A

Directly through the myometrium to the cervix and vagina

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22
Q

How do metastases occur in endometrial cancer?

A
  • Lymphatic system

- Haematogenous spread

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23
Q

When does haematogenous spread occur in endometrial cancer?

A

Usually late

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24
Q

What is the result of haematogenous spread occurring late in endometrial cancer?

A

Widespread metastasis at presentation is unusual

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25
Q

What can the risk factors for endometrial cancer be divided into?

A
  • Endogenous or exogenous

- High oestrogen levels or low progesterone levels

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26
Q

Give 2 endogenous causes of high oestrogen levels

A
  • Obesity

- Ovarian granulosa cell tumour

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27
Q

Give 2 exogenous causes of high oestrogen levels

A
  • Oestrogen-only HRT

- Tamoxifen

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28
Q

Give 4 endogenous causes of low progesterone levels

A
  • Polycystic ovarian syndrome
  • Nulliparity
  • Early menarche
  • Late menopause
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29
Q

What staging system is used for endometrial cancer?

A

FIGO

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30
Q

What is 1a endometrial cancer?

A

Disease in the body of the uterus, with invasion of <50% myometrium

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31
Q

What is 1b endometrial cancer?

A

Disease in the body of the uterus, with invasion of >50% of the myometrium

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32
Q

What is stage 2 endometrial cancer?

A

Disease in body of uterus and cervix

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33
Q

What is stage 3a endometrial cancer?

A

Disease advanced within the pelvis, with involvement of the ovaries

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34
Q

What is stage 3b endometrial cancer?

A

Disease advanced within the pelvis, with involvement of the vagina and parametrium

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35
Q

What is stage 3c endometrial cancer?

A

Disease advanced within the pelvis, with involvement of the local lymph nodes

36
Q

What is stage 4a endometrial cancer?

A

Disease spread to outside the pelvis, with involvement of bowel or bladder

37
Q

What is stage 4b endometrial cancer?

A

Disease spread outside the pelvis, with involvement of more distant organs

38
Q

What initial investigation is used in endometrial cancer?

A

Transvaginal ultrasound

39
Q

What is the purpose of the transvaginal ultrasound in the initial investigation of endometrial cancer?

A

Assess endometrial thickness

40
Q

What endometrial thickness is suggestive of endometrial cancer in post-menopausal women?

A

> 4mm

41
Q

Is an endometrial thickness of >4mm in post-menopausal women diagnostic of endometrial cancer?

A

No

42
Q

Is endometrial thickness a reliable indicator of endometrial cancer in pre-menopausal women?

A

No

43
Q

Why is endometrial thickness not a reliable indicator of endometrial cancer in pre-menopausal women?

A

Because endometrial thickness varies during the menstrual cycle

44
Q

What investigation is required to confirm a diagnosis of endometrial cancer?

A

Endometrial biopsy

45
Q

What biopsy techniques can be used to obtain an endometrial biopsy?

A
  • Pipelle
  • Hysteroscopy
  • Dilation and curettage
46
Q

What kind of endometrial biopsy cannot be used to diagnose endometrial cancer?

A

Pipelle

47
Q

Why can a pipelle biopsy not be used to diagnose endometrial cancer?

A

Because it does not assess if the basement membrane is breached

48
Q

What might be looked for on the blood sample in endometrial cancer?

A

CA125

49
Q

What is CA125 good for in endometrial cancer?

A

Disease monitoring

50
Q

What is the limitation of CA125 in endometrial cancer?

A

It is not sensitive or specific for endometrial cancer

51
Q

What investigations should be done if endometrial cancer is confirmed?

A
  • Chest x-ray
  • CT
  • Pelvic MRI
52
Q

What is the purpose of a CXR in endometrial cancer?

A

Check for pulmonary metastasis

53
Q

What is the purpose of a pelvic MRI scan in endometrial cancer?

A

Can assess the size and extent of invasion of the tumour into the cervix and myometrium

54
Q

What is the purpose of an examination under anaesthesia in endometrial cancer?

A

Assess size and mobility of uterus, and any involvement of vagina, cervix, bladder, or rectum

55
Q

Why might advanced endometrial cancer present with renal impairment?

A

Because it can cause hydronephrosis

56
Q

How is endometrial cancer staged?

A

Using the FIGO staging system

57
Q

What is the FIGO staging system based on?

A

Surgical and histological findings

58
Q

What is the result of the FIGO staging system for endometrial cancer being based on surgical features?

A

Accurate staging requires an operative procedure

59
Q

What does the treatment of endometrial cancer depend on?

A
  • The stage and grade of the cancer

- The general health of the woman

60
Q

What is usually sufficient in the treatment of women with stage 1a endometrial cancer?

A

Surgery with total abdominal hysterectomy and bilateral salpingo-oophrectomy

61
Q

When is the likelihood of lymph node involvement low in stage 1a endometrial cancers?

A

When the tumour is confined to the inner 1/3 of the myometrium

62
Q

How common is early stage endometrial cancer, compared to other stages?

A

The majority of women with endometrial cancer have early stage disease

63
Q

When is adjuvant pelvic radiotherapy given alongside surgery in endometrial cancer?

A

In women with stage 1b or 2 disease, or for high-grade cancers

64
Q

What is the purpose of adjuvant pelvic radiotherapy in endometrial cancer?

A

It reduces the rate of local recurrence

65
Q

When might radiotherapy be used as the primary treatment for endometrial cancer?

A
  • In women unfit to undergo surgery

- In women with locally advanced disease (stage 3 and 4a)

66
Q

What treatment is used for women with recurrent endometrial cancer?

A

Hormonal therapy using progesterones

67
Q

What is the purpose of hormonal therapy using progesterones in recurrent endometrial cancer?

A

It can be used to slow the growth of the cancer

68
Q

What do the best response rates to endocrine therapy in recurrent endometrial cancer correlate with?

A
  • Well-differentiated histology
  • Long disease-free interval following primary treatment
  • Increased expression of progesterone receptors
69
Q

What is the response rate to progesterone therapy in endometrial cancer?

A

25%

70
Q

What is the progression-free survival rate of progesterone therapy in endometrial cancer?

A

4 months

71
Q

What chemotherapy agents may be used in endometrial cancer?

A
  • Carboplatin and paclitaxel

- Cisplatin and doxorubicin

72
Q

What is the purpose of chemotherapy in endometrial cancer?

A

It can improve disease control and symptoms in patients with current disease

73
Q

What is the limitation of chemotherapy in endometrial cancer?

A

It’s impact on survival is limited

74
Q

Is there any benefit of chemotherapy given in an adjuvant therapy in endometrial cancer?

A

Limited

75
Q

Is there any benefit in combining chemotherapy with hormonal therapy?

A

No

76
Q

What short-term side effects may arise from pelvic radiotherapy?

A
  • Diarrhoea
  • Cystitis
  • Nausea
  • Tiredness
77
Q

What are the longer-term side effects of pelvic radiotherapy?

A
  • Early menopause
  • Vaginal dryness
  • Urinary frequency
  • Persistent diarrhoea
78
Q

How does pelvic radiotherapy cause urinary frequency?

A

Due to bladder wall fibrosis

79
Q

What side effects are associated with progesterone therapy?

A
  • Water retention
  • Breast tenderness
  • Nausea
  • Tiredness
80
Q

How does the prognosis of endometrial cancer differ from other gynaecological cancers?

A

It has the best prognosis of all the gynaecological cancers

81
Q

What are the poor prognostic factors of endometrial cancer?

A
  • Older age
  • Advanced stage
  • High-grade tumours
  • Adenosquamous histology
82
Q

At what location of disease is recurrent endometrial cancer most common?

A

The vaginal vault

83
Q

When does recurrent endometrial cancer often present?

A

Within 2-3 years of the primary treatment

84
Q

What is the 5 year survival of stage 1 endometrial cancer?

A

80%

85
Q

What is the 5 year survival of stage 2 endometrial cancer?

A

70-80%

86
Q

What is the 5 year survival or stage 3 endometrial cancer?

A

40-50%

87
Q

What is the 5 year survival of stage 4 endometrial cancer?

A

20-30%

Z - Cancer Care Old (28 decks)

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