Endometrial cancer

Question 1

Who is endometrial cancer seen in?

Answer 1

Post menopausal women

Question 2

What type of cancer are endometrial cancer? What are they related to?

Answer 2

Most are adenocarcinomas

Related to excessive exposure to oestrogen unopposed by progesterone

Question 3

What are risk factors for endometrial cancer?

Answer 3

Obesity
T2DM
Nulliparity - pregnancy is associated with high progesterone
Anovulatory cycles such as PCOS - absence of corpus luteum and therefore progesterone
Early menarche
Late menopause
Genetic predisposition - HNPCC (colorectal endometrial, ovarian cancer - lynch II syndrome)
Breast cancer
Oestrogen only HRT
Tamoxifen - stimulates oestrogen reeptor

Question 4

What are protective factors?

Answer 4

Parity

COCP

Question 5

What are clinical features of endometrial cancer?

Answer 5

Postmenopausal bleeding
Premenopausal women may have change in intermesntrual bleeding, heavy or irregular periods
PV discharge and pain are unusual features

Question 6

What investigation for endometrial cancer?

Answer 6

Women 55 or over who present with Postmenopausal Bleeding should be referred using cancer pathway

TVUS:
Endometrial thickness > 4mm
(Normal endometrial thickness <4mm has high negative predictive value)
Hysteroscopy with endometrial biopsy
CT/MRI for staging

Question 7

How is endometrial cancer staged?

Answer 7

I in the body of uterus only
II in the body and cervix only
III advancing beyond the uterus but not beyond the pelvis
IV extending outside the pelvis - e.g. to bowel and bladder

Question 8

What is management for endometrial cancer?

Answer 8

Localised disease - Total abdominal hysterectomy with bilateral salpigo-oophorectomy and peritoneal washings
- performed open or laparoscopically
Post-opertave radiotherapy for high-risk patients

Progesterone therapy sometimes used in frail elderly women not considered suitable for surgery

Question 9

What is endometrial hyperplasia? Features? Mx?

Answer 9

Abnormal proliferation of endometrium in excess of normal proliferation that occurs during the menstrual cycle

Abnormal vaginal bleeding

Mx:
Simple endometrial hyperplasia - high does progestogens with repeat sampling in 3-4 months
Levonorgestrel Intra-uterine system may be used
Atypical - hysterectomy

Question 10

What is endometrial sampling? Who is it for?

Answer 10

Bedside investigation for postmenopausal bleeding, women >45 with abnormal menstrual symptoms and unexpected bleeding patterns in women on HRT

IF transvaginal US, shows endometrium > 4mm thick, sample.

Sample is obtained using side opening plastic cannula in which vacuum plunger allow endometrial tissue to be sucked in.

Question 11

What should you do if there is polyps or fibroid or necrotic tissue on endometrial sampling?

Answer 11

Refer for hysteroscopy and biopsy