Endometrial Cancer Flashcards
What is endometrial cancer?
A cancer arising from the lining of the uterus
How common is endometrial cancer?
The 4th most common cancer in women in the UK
How many new cases of endometrial cancer are there each year in the UK?
8,600
How many deaths are caused by endometrial cancer each year in the UK?
2,300
What is the median age of endometrial cancer?
63
What % of women with endometrial cancer are over 50?
90%
Where is endometrial cancer more common?
Western societies
What is the most common histological type of endometrial cancer?
Adenocarcinoma
What % of endometrial cancer is adenocarcinoma?
80%
What are the two main types of endometrial cancer?
- Type 1
- Type 2
What is Type 1 endometrial cancer?
Oestrogen dependent endometrioid
What is Type 2 endometrial cancer?
Oestrogen independent non-endometrioid
What are the risk factors for endometrial cancer?
- Prolonged periods of unopposed oestrogen
- Nulliparous
- Menopause past 52
- Obesity
- Endometrial hyperplasia
- PCOS
- DM
- Tamoxifen
What is the main risk factor for endometrial cancer?
Prolonged unopposed oestrogen
What can cause prolonged periods of unopposed oestrogen?
- Medication
- Anovulatory cycles where corpus luteum does not mature and secrete progesterone
What is endometrial hyperplasia?
Excessive proliferation of the cells of the endometrium
Why is endometrial hyperplasia a significant finding?
It is a significant risk factor for the development of endometrial cancer
What is essential in women with endometrial hyperplasia?
Careful monitoring and treatment
What causes most cases of endometrial hyperplasia?
High levels of oestrogen combined with insufficient progesterone
Why is sufficient progesterone important in preventing endometrial cancer and hyperplasia?
It normally counteracts the pro-proliferative effects of oestrogen on the tissues
What are the classifications of endometrial hyperplasia?
- Hyperplasia without atypia
- Atypical hyperplasia
Which type of endometrial hyperplasia is considered a pre-malignant condition of the uterus?
Atypical hyperplasia
How does endometrial hyperplasia normally present?
- Abnormal vaginal bleeding
- Sometimes vaginal discharge
What types of abnormal vaginal bleeding may occur in endometrial hyperplasia?
- Intermenstrual bleeding
- Irregular bleeding
- Menorrhagia
- Post-menopausal bleeding
How is endometrial hyperplasia definitively diagnosed?
Biopsy
How can biopsy to test for endometrial hyperplasia be obtained?
- Outpatient endometrial sampling with pipelle biopsy
- Hysteroscopy and curettage biopsy
When is an endometrial curettage biopsy preferred to pipelle biopsy?
When there are polyps and other benign lesions
What investigation may be useful in identifying potential endometrial hyperplasia prior to biopsy?
Transvaginal USS
Can an endometrial biopsy be performed regardless of transvaginal USS results?
Yes, if clinical suspicion is high
What does the interpretation of the results of a transvaginal USS for suspected endometrial hyperplasia depend upon?
Whether she is pre- or post-menpausal
Which group of women is endometrial thickness on transvaginal USS less helpful in determining likelihood of endometrial hyperplasia?
Pre-menopausal women
Why is endometrial thickness less helpful in pre-menopausal women?
Due to the cyclical change and overlap between normal proliferative endometrium and hyperplasia
What can a transvaginal USS in pre-menopausal women help to identify (other than endometrial hyperplasia)?
Abnormalities such as polyps
What endometrial thickness in pre-menopausal women is unlikely to suggest endometrial hyperplasia?
<7mm
What can endometrial thickness in post-menopausal women be used to determine?
Need for biopsy/hysteroscopy
What is the cut off endometrial thickness for requiring endometrial biopsy/hysteroscopy in post-menopausal women?
3-4mm
What can treatment of endometrial hyperplasia include?
- Conservative management
- Hormonal therapy
- Hysterectomy
What are the management options for endometrial hyperplasia without atypia?
- Reassurance
- Address risk factors
- Watchful waiting
- Progestogen treatment