Endometrial cancer

Question 1

Aetiology of endometrial cancer?

Answer 1

Post-menopausal women, High circulating oestrogen levels = obesity, unopposed E2 therapy/Tamoxifen, Polycystic ovarian syndrome (PCOS), early menarche/late menopause. Atypical endometrial hyperplasia. HNPCC/Lynch type II familial cancer syndromeHigh oestrogen / progesterone ratio, Nulliparity, Late menopause, Polycystic ovarian syndrome (if long term amenorrhoea), Obesity, Unopposed oestrogens and tamoxifen, Diabetes mellitus, Family history of breast, ovary or colon carcinoma (THIS TYPICALLY PRESENTS WITH BLEEDING IN POSTMENOPAUSAL WOMEN. In pre-menopausal women it can be associated with irregular vaginal bleeding and menorrhagia. dx is endometrial biopsy via a pipelle and hysteroscopy to ensure no abnormalities are missed.)

Question 2

RF’s of endometrial cancer

Answer 2

Obesity, long term use of tamoxifen, nulliparity, late menopause, DM, PCOS, unopposed oestrogen stimulation, age.

Question 3

what is protective?

Answer 3

COCP, Pregnancy

Question 4

sy/sx

Answer 4

abnormal vaginal bleeding, Postmenopausal bleeding (PMB), blood stained vaginal discharge

Question 5

DDX

Answer 5

Incomplete cessation of menses, cervical cancer, ovarian cancer, cervical polyp, endometrial polyp, atropic vaginitis (also seee the causes of Postmenopausal bleeding below)

Question 6

what are the other causes of PMB

Answer 6

8% of women with PMB will have endometrial cancer, Hormone Replacement Therapy (HRT), Peri-menopausal bleeding, Atrophic vaginitis, Polyps cervical/endometrial, Other cancer eg cervix, vulva, bladder,anal

Question 7

dx/ix

Answer 7

Post menopausal: transvaginal USS, Biopsy = Pipelle or during hysteroscopy If endometrium thickness > 5mm (on USS) or multiple episodes of bleeding.
ENDOMETRIAL BIOPSY VIA PIPELLE, CA125 TUMOUR MARKER, CERVICAL SMEAR, PELVIC USS, HYSTEROSCOPY, BLOOD LEVELS OF FSH and LH.

Question 8

Endometrial Cancer staging (FIGO 2009)

Answer 8

1a - inner half of myometrium, 1b - outer half of myometrium
2 - invades the cervix
3a - serosa, 3b - vaginal/parametrium, pelvic or para-aortic lymph nodes
4 - bladder/bowel/abdo/ inguinal nodes

Question 9

Type 1 Endometrial cancer

Answer 9

Endometrioid adenocarcinoma, By far the commonest, Unopposed oestrogen, Hyperplasia with atypia precursor

Question 10

Type 2 Endometrial cancer

Answer 10

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

Question 11

tx

Answer 11

Early Stage = Surgery: Total abdominal hysterectomy/Bilateral salphingo oopherectomy/washings
High risk histology = Chemotherapy
Advanced Stage = Radiotherapy
Palliation = Progesterone

Question 12

comlications of surgery

Answer 12

urethra damage, thrmoboembolism, stress incontinence, risk of herniation through the scar site.

Question 13

What other gynecologucal conditions require a hysterectomy?

Answer 13

severe endometriosis, other cancers, menorrhagia, PID with chronic pain.