Endometrial cancer Flashcards
How can post-menopausal bleeding (PMB) be investigated?
Pelvic and speculum exam
TVUS
Endometrial biopsy
What is a TVUS?
Trans vaginal ultrasound
What does a TVUS investigate?
Endometrial thickness
Endometrial contour
When would you perform an endometrial biopsy?
If endometrial thickness on TVUS >4mm or irregular
What is a TLH?
Total laparoscopic hysterectomy
What is a BSO?
Bilateral salpingoophorectomy
What are peritoneal washings?
Salt-water solution is used to wash the peritoneal cavity and then is removed to check for cancer cells
What are pathological prognostic features used in endometrial cancer?
Histological type
Histological grade
Stage
LVSI
What is LVSI?
Lymphovascular space invasion
Why is LVSI important in endometrial cancer?
Independent risk factor for pelvic lymph node metastasis and is present in about 15% of early-stage endometrial cancers
How is staging done for endometrial cancer?
Surgical/pathological
MRI
What does the MRI investigate for staging of endometrial cancer?
Depth of myometrial invasion
Cervical involvement
Lymph node involvement
What is the staging system for endometrial cancer?
FIGO 2009
What does stage 1A FIGO 2009 mean?
Inner half of myometrium
What does stage 1B FIGO 2009 mean?
Outer half of myometrium
What does stage 2 FIGO 2009 mean?
Invades cervix
What does stage 3A FIGO 2009 mean?
Serosa/adnexa
What does stage 3B FIGO 2009 mean?
Vagina/parametrium
What does stage 3C FIGO 2009 mean?
Pelvic or para-aortic nodes
What does stage 4 FIGO 2009 mean?
Bladder/bowel/intra-abdominal/inguinal nodes
What are the two distinct categories of endometrial cancer?
Type 1
Type 2
What is Type 1 endometrial cancer?
Endometrioid adenocarcinoma
What is Type 2 endometrial cancer?
Uterine serous & clear cell carcinoma
What is the most common type of endometrial cancer?
Type 1 endometriosis adenocarcinoma
What type of endometrial cancer is high grade, more aggressive and has a worse prognosis?
Type 2 - uterine serious & clear cell carcinoma
Which age group tends to get Type 2 endometrial cancer?
Older women
What is unopposed oestrogen?
Oestrogen produced post menopause, unopposed oestrogen causes the cells of the endometrium to divide, which can increase the risk of womb cancer
What are Type 1 endometrial cancers linked to?
Excess oestrogen
What is the treatment of early stage endometrial cancer?
Surgery
TAH/BSO/washings
What is the treatment of advanced stage endometrial cancer?
Radiotherapy
What is used during palliation of endometrial cancer?
Progesterone
What is the treatment of endometrial cancer if there is high risk histology?
Chemotherapy
When does endometrial cancer tend to develop in women?
Post-menopause
High circulating oestrogen levels
Atypical endometrial hyperplasia
Genetic: HNPCC/Lynch syndrome
What can cause high circulating levels of oestrogen?
Obesity
Unopoosed E2 therapy/tamoxifen
PCOS
Early menarche/late menopause
How can Tamoxifen cause endometrial cancer?
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.
What are the main symptoms of endometrial cancer?
Abnormal vaginal bleeding
Post menopausal bleeding (PMB)
What percentage of women with PMB will have endometrial cancer?
8%
What else can cause PMB?
HRT Peri-menopausal bleeding Atrophic vaginitis Polyps cervical/endometrial Other cancer: cervix, vulva, bladder, anal
Are older or younger women more likely to get endometrial cancer?
Older
What is the main treatment for endometrial cancer?
TAH and BSO - and peritoneal washings
How is the main diagnosis of endometrial cancer done?
Histological
What are risk factors for endometrial cancer?
High oestrogen/progesterone ratio Nulliparity Late menopause PCOS Obesity Unopposed oestrogens and tamoxifen DM FH breast, ovary or colon
What are protective factors for endometrial cancer?
OCP
Pregnancy
What are the investigations for endometrial cancer?
USS
Biopsy
