Endometrial Cancer

Question 1

Name 3 investigations for Post-menopausal bleeding

Answer 1

Transvaginal Ultrasound
Endometrial Biopsy
Hysteroscopy

Question 2

Which 2 features of the endometrium can be measured/observed using transvaginal ultrasound?

Answer 2

Endometrial thickness

Endometrial contour

Question 3

What is the significance of measuring endometrial thickness in the case of postmenopausal bleeding?

Answer 3

Endometrium should not be in cycle of thickening and shedding - no oestrogen or progesterone produced

Question 4

Why would a biopsy be taken to investigate post menopausal bleeding?

Answer 4

Endometrial thickness greater than 4 mm or irregular

Question 5

What irregularities may be present in the endometrium indicating the need for a biopsy?

Answer 5

Polyps

Fluid

Question 6

How would an endometrium biopsy be sampled?

Answer 6

Pipelle

Question 7

What are the typical findings from a hysteroscopy in a postmenopausal patient?

Answer 7

Thin
Atrophic
Pale

Question 8

Treatment for postmenopausal bleeding

Answer 8

Total Laparoscopic Hysterectomy
Bilateral salpingoophorectomy BSO
Peritoneal washings

Question 9

In what settings can a hysteroscopy be carried out?

Answer 9

Inpatient under General Anaesthetic

Outpatient under Local Anaesthetic

Question 10

4 Pathological Prognostic Features in Endometrial cancer

Answer 10

Histological Type
Histological Grade
Stage
Lymphovascular Space Involvement LSI

Question 11

What is meant by the histological grade of an endometrial cancer?

Answer 11

Proportion of gland formation

Question 12

2 purposes of Staging of endometrial cancer

Answer 12

Surgical

Pathological

Question 13

What imaging technique is used to stage Endometrial Cancer?

Answer 13

MRI

Question 14

What is measured on MRI to stage an endometrial cancer?

Answer 14

Depth of myometrial invasion
Cervical involvement
Lymph node involvement

Question 15

What is the name of criteria used to stage endometrial cancer?

Answer 15

FIGO

2009

Question 16

Describe the endometrial cancer staging FIGO criterai

Answer 16

1A - Inner half myometrium
1B - Outer half myometrium 
2 - Invades cervix
3A - Serosa/adnexa
3B - Vagina/Parametrium
3C - Pelvic or Paraaortic nodes
4 - Bladder/Bowel/Intra-abdominal/Inguinal nodes

Question 17

How many types of endometrial cancer are there?

Answer 17

Type 1 and Type 2

Question 18

What is the most common type of endometrial cancer?

Answer 18

Type 1

Question 19

What type of tumour is type 1 endometrial cancer?

Answer 19

Endometroid adenocarcinoma

Question 20

Which type of endometrial cancer is common in premenopausal and obese patients?

Answer 20

Type 1

Question 21

Histological findings in Type 1 Endometrial cancer

Answer 21

Hyperplasia with atypia precursor

Question 22

Describe the tumour of Type 2 Endometrial cancer

Answer 22

Uterine serous and clear cell carcinoma

Question 23

Which type of endometrial cancer has a worse prognosis?

Answer 23

Type 2 - high grade, more aggressive

Question 24

In which group of patients is Type 2 Endothelial cancer more common?

Answer 24

Late menopausal - generally older women

Question 25

Which type of precursor is found in Type 2 Endothelial cancers?

Answer 25

Serous intraepithelial carcinoma precursor

Question 26

Which type of cells are produced by a uterine carcinosarcoma and how does it behave?

Answer 26

Bone and cartilage | Very aggressive

Question 27

Treatment of early stage endometrial cancer

Answer 27

Total Abdominal Hysterectomy Bilateral Salpingoopherectomy Peritoneal washings

Question 28

Treatment of endometrial cancer with high risk histology

Answer 28

Chemotherapy

Question 29

Treatment of advanced stage Endometrial Cancer

Answer 29

Radiotherapy

Question 30

How is endometrial cancer palliated?

Answer 30

Progesterone

Question 31

4 Factors/Patient groups found in cases of endometrial cancer

Answer 31

Post menopausal High circulating oestrogen levels HNPCC/Lynch Type II Familial cancer syndrome Atypical endometrial hyperplasia

Question 32

Symptoms of endometrial cancer

Answer 32

Post menopausal bleeding | Abnormal vaginal bleeding

Question 33

Reasons for postmenopausal bleeding (6)

Answer 33

``` Endometrial cancer (8%) Hormone Replacement Therapy Perimenopausal bleeding Atrophic vaginitis Polyps - cervical/endometrial Other cancers - cervical/vulva/bladder/anal ```

Question 34

Three features of atrophic vaginitis

Answer 34

Post coital bleed Non infectious Tissue undergone early trauma Thinner - Dehydration

Question 35

Diagnosis of Endometrial cancer

Answer 35

Histology of endometrium

Question 36

Reasons for high circulating levels of oestrogen

Answer 36

Obesity - peripheral production Unopposed E2 therapy/Tamoxifen Polycystic Ovarian Syndrome PCOS Early menarche/late menopause

Question 37

Why does PCOS cause a high circulating level of oestrogen

Answer 37

Anovulation - no fall in oestrogen levels

Question 38

What effect does early menarche/late menopause have on endometrium?

Answer 38

Allows it to thicken, create space | Myometrium effects occur as well