Endometrial Cancer

Question 1

Incidence

Answer 1

• Most common gynaecological cancer in the UK
• Peak incidence aged 70-74 years
• 58% in over 65s

Question 2

Presentation

Answer 2

• Postmenopausal bleeding (PMB)
• Post coital bleeding (PCB)
• Intrmenstrual bleeding (IMB)
• Altered menstrual pattern
• Persistent vaginal discharge

Question 3

Types of endometrial cancer

Answer 3

• Adenocarcinoma (most common)
  
  • Type 1
    
    • Oestrogen excess
    • Endometroid commonest
  • Type 2
    
    • Papillary serous (5%)
    • Clear cell (1%)
• Sarcoma
  
  • Derived from muscle layer
  • Leiomyosarcoma most common
• Uterine carcinosarcoma

Question 4

Preceding conditions

Answer 4

• Simple hyperplasia (1-3% progress)
• Complex hyperplasia (3-4% progress)
• Atypical hyperplasia (23% progress)

Question 5

Risk factors (remember OLD AUNT)

Answer 5

• Obesity
• Late menopause Physical inactivity
• Diabetes
• cAncer (breast, ovarian, colon)
• Unopposed oestrogen exposure, PCOS, anovulation, HRT
• Nulliparity
• Tamoxifen
• Metabolic syndrome
• Genetics (HNPCC - Lynch II)

Question 6

Staging

Answer 6

FIGO

Question 7

Investigations

Answer 7

• Bloods (nil specific)
• Transvaginal scan (measure endometrial thickness)
• MRI (assess for extrauterine disease)
• CT/PET-CT
• Biopsy
  
  • If ET>5, (non-HRT and CC-HRT users)
  • If ET>5mm (sequential HRT users)
  • Hysteroscopy/biopsy in Tamoxifen users

Question 8

Treatment

Answer 8

• TH + BSO + washings
• Adjuvant treatment based on histopathological features