Endometrial Cancer

Question 1

Investigations for post-menopausal bleeding

Answer 1

• Transvaginal USS
  
  • Measure endometrial thickness
  • Looks at endometrial contour
  • Biopsy if >4mm or irregular
  • Only in postmenopausal women as thickness changes
• Endometrial biopsy
  
  • Pipelle
    
    • Blind, suitable for most women
  • Hysteroscopy
    
    • local or general anaesthetic

Question 2

Cause of endometrial cancer

Answer 2

• High/constant (unlike cycle) circulating levels of oestrogen
  
  • Obesity - abdominal fat produces oestrogen
  • Unopposed E2 therapy/tamoxifen (opposes oestrogen in breast cancer but ask like it on endometrium)
  • PCOS
  • Early menarche/late menopause
• Atypical endometrial hyperplasia
• HNPCC/Lynch type III familial cancer

Question 3

Symptoms of endometrial cancer

Answer 3

• Abnormal vaginal bleeding
• PMB

Question 4

Causes of PMB

Answer 4

• 8% of women with PMB have endometrial cancer
• HRT
• Not in peri-menopausal - irregular
• Atrophic vaginitis
• Polyps cervical/endometrial (only investigates if PM)
• Other cancer e.g. cervix, vulva, bladder, anal
  
  • Patient difficult to identify origin

Question 5

How is endometrial cancer staged

Answer 5

• Surgical/pathological
• MRI
• based on
  
  • Depth of myometrial invasion
  • cevrical involvement
  • Lymph node involvement

Question 6

Stages of endometrial cancer

Answer 6

• FIGO staging

Stage

1A

Inner half of myometrium

1B

Outer half of myometrium

2

Invades cervix

3A

Serosa/adnexa

3B

Vagina/parametrium

3C

Pelvic or para-aortic nodes

4

Bladder/bowel/intra-abdominal/inguinal nodes

Question 7

What FIGO stage does endometrial cancer usually present at

Answer 7

• 1 - bleeding occurs early

Question 8

Type 1 endometrial cancer

Answer 8

• Endometroid adenocarcinoma
• Commonest
• Unopposed oestrogen
• Hyperplasia with atypia precursor
• Tend to be younger

Question 9

Type 2 endometrial cancer

Answer 9

• Uterine serous & clear cell carcinoma
• High grade, more aggressive, worse prognosis
• Generally older women
• Serous intraepithelial carcinoma precursor

Question 10

Treatment of endometrial cancer

Answer 10

• Early
  
  • Surgery TAH/BSO/washings
• high risk histology
  
  • Chemo
• Advanced stage
  
  • Radiotherapy
• Palliation
  
  • Progesterone - helps with heavy bleeding

Question 11

Cure rates by stage of endometrial cancer

Answer 11

• IB - 85%
• IIA - 75%
• IIB - 60%
• IIIB - 30%
• IV - 21%