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Year 3 - Reproduction > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

1
Q

If there is post-menopausal bleeding which investigations would be carried out in the post-menopausal bleeding clinic?

What are you looking for?

A

1) Pelvic and speculum examination

2) Trans-vaginal ultrasound scan:
- Measure endometrial thickness
- Looks at the endometrial contour
- Biopsy if >4mm or irregular

3) Endometrial biopsy:
- E.g. Pipelle

4) Hysteroscopy:
- Out patient with local
- In patient with general

Endometrial cancer

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2
Q

Which pathological prognostic features are there for endometrial cancer?

A
  1. Histological type
  2. Histological grade
  3. Stage
  4. LVSI
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3
Q

How would you confirm endometrial cancer and stage?

A

Confirmation:

1) Ultrasound
2) Endometrial biopsy

Staging:
1) Surgical/Pathological

2) MRI
- Depth of myometrial invasion
- Cervical involvement
- Lymph node involvement

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4
Q

Endometrial cancer staging - Stage 1a?

A

Inner half of myometrium

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5
Q

Endometrial cancer staging - Stage 1b?

A

Outer half of myometrium

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6
Q

Endometrial cancer staging - Stage 2?

A

Invades cervix

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7
Q

Endometrial cancer staging - Stage 3a?

A

Serosa/adnexa

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8
Q

Endometrial cancer staging - Stage 3b?

A

Vagina/parametrium

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9
Q

Endometrial cancer staging - Stage 3c?

A

Pelvic or para-aortic nodes

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10
Q

Endometrial cancer staging - Stage 4?

A

Bladder/bowel/intra-abdominal/inguinal nodes

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11
Q

What are the two distinct categories of endometrial cancer?

A

1) Type 1 = Endometrioid adenocarcinoma (Hyperplasia)

2) Type 2 = Uterine serous and clear carcinoma (Sporadic)

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12
Q

Which category of endometrial cancer is the most common?

A

Type 1 = Endometrioid adenocarcinoma (Hyperplasia) = 75% case

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13
Q

What is the average age of presentation of type 1, Endometrioid adenocarcinoma (Hyperplasia)?

A

60 years old

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14
Q

What is the average age of presentation of type 2, Uterine serous and clear carcinoma (Sporadic)?

A

70 years old

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15
Q

Histology of type 1 endometrial cancer?

A

Endometrioid (normal epithelium like) adenocarcinoma

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16
Q

Histology of type 2 endometrial cancer?

A

Uterine serous and is characterised by papillary structures with psammoma body formation

17
Q

Which mutation is common within type 2, Uterine serous and clear carcinoma (Sporadic)?

A

p53 mutation

18
Q

Which type of endometrial carcinoma is more aggressive?

A

Type 2, Uterine serous and clear carcinoma is high grade, more aggressive, and has a worse prognosis

19
Q

Which type of endometrial cancer is stimulated by oestrogen exposure?

A

Type 1, Endometrioid adenocarcinoma (Hyperplasia)

20
Q

What risk factors are there for type type 1, Endometrioid adenocarcinoma (Hyperplasia)?

A

Oestrogen exposure so:
1) Early menarche/late menopause

2) Nulliparity
3) Infertility with anovulatory cycles
4) Obesity
5) Unopposed E2 therapy/Tamoxifen
6) Polycystic ovarian syndrome (PCOS)
7) HNPCC/Lynch type II familial cancer syndrome
8) Endometrial hyperplasia

21
Q

Treatment of endometrial cancer - Early cancer?

A

Surgery TAH/BSO/washings

22
Q

Treatment of endometrial cancer - high risk histology?

A

Chemotherapy

23
Q

Treatment of endometrial cancer - advance stage?

A

Radiotherapy - External beam

24
Q

Treatment of endometrial cancer - Palliation?

A

Progesterone

25
Q

Treatment of endometrial cancer?

A

1) Early = Surgery TAH/BSO/washings
2) High risk histology = Chemotherapy
3) Advanced stage = Radiotherapy
4) Palliation = Progesterone

Others:
> Caesium insertion:
- Intra-cavity
- Vault

26
Q

Endometrial cancer cure rates - Stage 1b?

A

85%

27
Q

Endometrial cancer cure rates - Stage 2a?

A

75%

28
Q

Endometrial cancer cure rates - Stage 2b?

A

60%

29
Q

Endometrial cancer cure rates - Stage 3b?

A

30%

30
Q

Endometrial cancer cure rates - Stage 4?

A

21%

31
Q

What are the symptoms of endometrial cancer?

A

> Abnormal vaginal bleeding

> Post menopausal bleeding

32
Q

What are the rates of endometrial cancer in post-menopausal bleeding?

A

8% of women with PMB will have endometrial cancer

33
Q

What are the causes of post-menopausal bleeding?

A

1) Endometrial cancer
2) Hormone replacement therapy
3) Peri-menopausal bleeding
4) Atrophic vaginitis
5) Polyps cervical/endometrial
6) Other cancers e.g. cervix, vulva, bladder, anal

34
Q

Incidence of endometrial cancer in the UK?

A

> 9234 new cases in 2014

> 29.8 per 100,000

> 1% per 100,000 women aged 40

35
Q

Deaths from endometrial cancer in the UK?

A

> 2166 deaths in 2014

> 6.7 per 100,000 women

36
Q

5 year survival rates of endometrial cancer overall?

A

78%

37
Q

5 year survival rates of endometrial cancer overall - Stage 1?

A

95%

38
Q

5 year survival rates of endometrial cancer overall Stage 4?

A

14%

39
Q

What is the main treatment for endometrial cancer?

A

Total abdominal hysterectomy with removal of tubes (salpingectomy) and peritoneal washing

Year 3 - Reproduction (25 decks)

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