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Reproductive > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

1
Q

How can post-menopausal bleeding (PMB) be investigated?

A

Pelvic and speculum exam
TVUS
Endometrial biopsy

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2
Q

What is a TVUS?

A

Trans vaginal ultrasound

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3
Q

What does a TVUS investigate?

A

Endometrial thickness

Endometrial contour

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4
Q

When would you perform an endometrial biopsy?

A

If endometrial thickness on TVUS >4mm or irregular

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5
Q

What is a TLH?

A

Total laparoscopic hysterectomy

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6
Q

What is a BSO?

A

Bilateral salpingoophorectomy

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7
Q

What are peritoneal washings?

A

Salt-water solution is used to wash the peritoneal cavity and then is removed to check for cancer cells

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8
Q

What are pathological prognostic features used in endometrial cancer?

A

Histological type
Histological grade
Stage
LVSI

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9
Q

What is LVSI?

A

Lymphovascular space invasion

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10
Q

Why is LVSI important in endometrial cancer?

A

Independent risk factor for pelvic lymph node metastasis and is present in about 15% of early-stage endometrial cancers

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11
Q

How is staging done for endometrial cancer?

A

Surgical/pathological

MRI

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12
Q

What does the MRI investigate for staging of endometrial cancer?

A

Depth of myometrial invasion
Cervical involvement
Lymph node involvement

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13
Q

What is the staging system for endometrial cancer?

A

FIGO 2009

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14
Q

What does stage 1A FIGO 2009 mean?

A

Inner half of myometrium

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15
Q

What does stage 1B FIGO 2009 mean?

A

Outer half of myometrium

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16
Q

What does stage 2 FIGO 2009 mean?

A

Invades cervix

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17
Q

What does stage 3A FIGO 2009 mean?

A

Serosa/adnexa

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18
Q

What does stage 3B FIGO 2009 mean?

A

Vagina/parametrium

19
Q

What does stage 3C FIGO 2009 mean?

A

Pelvic or para-aortic nodes

20
Q

What does stage 4 FIGO 2009 mean?

A

Bladder/bowel/intra-abdominal/inguinal nodes

21
Q

What are the two distinct categories of endometrial cancer?

A

Type 1

Type 2

22
Q

What is Type 1 endometrial cancer?

A

Endometrioid adenocarcinoma

23
Q

What is Type 2 endometrial cancer?

A

Uterine serous & clear cell carcinoma

24
Q

What is the most common type of endometrial cancer?

A

Type 1 endometriosis adenocarcinoma

25
Q

What type of endometrial cancer is high grade, more aggressive and has a worse prognosis?

A

Type 2 - uterine serious & clear cell carcinoma

26
Q

Which age group tends to get Type 2 endometrial cancer?

A

Older women

27
Q

What is unopposed oestrogen?

A

Oestrogen produced post menopause, unopposed oestrogen causes the cells of the endometrium to divide, which can increase the risk of womb cancer

28
Q

What are Type 1 endometrial cancers linked to?

A

Excess oestrogen

29
Q

What is the treatment of early stage endometrial cancer?

A

Surgery

TAH/BSO/washings

30
Q

What is the treatment of advanced stage endometrial cancer?

A

Radiotherapy

31
Q

What is used during palliation of endometrial cancer?

A

Progesterone

32
Q

What is the treatment of endometrial cancer if there is high risk histology?

A

Chemotherapy

33
Q

When does endometrial cancer tend to develop in women?

A

Post-menopause
High circulating oestrogen levels
Atypical endometrial hyperplasia
Genetic: HNPCC/Lynch syndrome

34
Q

What can cause high circulating levels of oestrogen?

A

Obesity
Unopoosed E2 therapy/tamoxifen
PCOS
Early menarche/late menopause

35
Q

How can Tamoxifen cause endometrial cancer?

A

Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause the uterine lining to grow, which increases the risk of endometrial cancer.

36
Q

What are the main symptoms of endometrial cancer?

A

Abnormal vaginal bleeding

Post menopausal bleeding (PMB)

37
Q

What percentage of women with PMB will have endometrial cancer?

A

8%

38
Q

What else can cause PMB?

A 
HRT
Peri-menopausal bleeding
Atrophic vaginitis
Polyps cervical/endometrial
Other cancer: cervix, vulva, bladder, anal
39
Q

Are older or younger women more likely to get endometrial cancer?

A

Older

40
Q

What is the main treatment for endometrial cancer?

A

TAH and BSO - and peritoneal washings

41
Q

How is the main diagnosis of endometrial cancer done?

A

Histological

42
Q

What are risk factors for endometrial cancer?

A 
High oestrogen/progesterone ratio
Nulliparity
Late menopause
PCOS
Obesity
Unopposed oestrogens and tamoxifen
DM
FH breast, ovary or colon
43
Q

What are protective factors for endometrial cancer?

A

OCP

Pregnancy

44
Q

What are the investigations for endometrial cancer?

A

USS

Biopsy

Reproductive (20 decks)

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