Endometrial cancer

Question 1

Management of presentation of post-menopausal woman with vaginal bleeding?

Answer 1

2-week referral
Transvaginal ultrasounds to measure endometrial thickness
Hysteroscopy with endometrial biopsy

Question 2

What proportion of cases of endometrial cancer happen before menopause?

Answer 2

25%

Question 3

What are the risk factors for endometrial cancer?

Answer 3

Obesity
Nulliparity, early menarche, late menopause
Unopposed oestrogen (eliminated if HRT. also has progesterone)
Diabetes mellitus
Tamoxifen
PCOS
Hereditary non-polyposis colorectal carcinoma

Question 4

Features of endometrial cancer:

Answer 4

Postmenopausal bleeding
Premenopausal women may have a change in inter-menopausal bleeding
Pain and discharge are unusual features

Question 5

Treatment for endometrial cancer:

Answer 5

Localised disease = total abdominal hysterectomy with bilateral salpingo-oophorectomy. Post-op RT for high risk
Progesterone therapy in patients too frail for surgery

Question 6

Protective factors against endometrial cancer?

Answer 6

Smoking

Oral contraceptive pill

Question 7

Management of borderline/mild dyskaryosis?

Answer 7

Original sample tested for HPV

If +ve then colposcopy

Question 8

Management of moderate/severe dyskaryosis or invasive cancer?

Answer 8

Refer for urgent colposcopy within 2 weeks

Question 9

Presentation of choriocarcinoma?

Answer 9

Vaginal bleeding
Signs of hyperthyroidism e.g. feel hot and diarrhoea
Recent pregnancy
Miscarriage

Question 10

Associated findings in choriocarcinoma?

Answer 10

Elevated hCG
Hyperthyroid symptoms as hCG can activate TSH receptors
Metastases to the lungs

Question 11

What is alpha-fetoprotein a tumour marker for?

Answer 11

Hepatocellular carcinoma
Hepatoblastoma
Mixed germ cell tumour
Yolk sac tumour

Question 12

What is alkaline phosphatase a tumour marker for?

Answer 12

Bone and liver metastases
Germ cell tumours e.g. seminoma
Also it is elevated in Paget’s disease of the bone

Question 13

What is chromogranin a tumour marker for?

Answer 13

Neuroendocrine tumours e.g. intestinal, lung, pancreas, thyroid, and adrenal

Question 14

Gestational trophoblastic disorders:

Answer 14

Complete hydatidiform mole
Partial hydatidiform mole
Choriocarcinoma

Question 15

What is a complete hydatidiform mole?

Answer 15

A sperm fertilises an empty egg and duplicates its own DNA meaning all the DNA is paternal

Question 16

Features of complete hydatidiform mole?

Answer 16

1st and 2nd trimester bleeding
Exaggerated pregnancy symptoms e.g. hyperemesis
Uterus large for dates
Very high serum hCG
Hypertension and hyperthyroidism may be seen

Question 17

Why may hyperthyroidism be seen in complete hydatidiform mole?

Answer 17

Because there is high hCG and hCG mimics TSH

Question 18

What is a partial hydatidiform mole?

Answer 18

Haploid egg gets fertilised by two sperms or one sperm that duplicates its own DNA. Usually triploid e.g. 69 XXX or 69 XXY. Fatal parts may be seen