Endometrial cancer

Question 1

What are the risk factors for endometrial cancer?

Answer 1

Diabetes
Obesity

Nulliparity (increased oestrogen exposure)
Oestrogen
Tamoxifen

HNPCC i.e Lynch Syndrome
Early menarche (increased oestrogen exposure)
Late menopause (increased oestrogen exposure)
PCOS

Oestrogen –> results in buildup of endometrium (can cause too much growth if unchecked)

Question 2

What is the most common form of endometrial cancer? Give 3 other types.

Answer 2

Adenocarcinoma (90%)

3 other types:

1. Adenosquamous (2nd most common, poorer prognosis)
2. Squamous
3. Uterine sarcoma
4. Papillary serous
5. Clear cell

Question 3

2 prognostic indicators in Endometrial cancer?

Answer 3

FIGO staging
Grade of differentiation
• Well differentiated (G1).
• Moderately differentiated (G2).
• Poorly differentiated or high risk cell type (G3).

Question 4

What are the SSx of endometrial cancer?

Answer 4

Post-menopausal bleeding

Premenopausal women:
Irregular or intermenstrual bleeding
Recent onset menorrhagia

Question 5

What is the first-line investigation for endometrial cancer?

Answer 5

Transvaginal USS to assess endometrial thickness

Question 6

What are the indications for endometrial sampling in suspected endometrial cancer?

Answer 6

> 4mm –> Pipelle biopsy

< 4mm and persistent bleeding –> hysteroscopy

Question 7

You are a GP. Lady has come in, 56 years old with Post menopausal bleeding. What do you do next?

A) Arrange for routine Gynae oncology appt
B) 2 WW referral
C) Arrange for USS
D) Arrange for hysteroscopy
E) Prescribe tranexamic acid

Answer 7

2 WW referral

Question 8

What are the considerations for direct access USS for suspected endometrial cancer in women?

Answer 8

Age 55 and over with:
Unexplained symptoms of vaginal discharge who:
Are presenting with these symptoms for the first time, or
Have thrombocytosis, or
Report haematuria, or
Visible haematuria, and:
-Low haemoglobin levels, or
-Thrombocytosis, or
-High blood glucose levels

(NICE recommendation for 2015).

Question 9

What to do next if pipelle biopsy fails to provide sample?

Answer 9

Hysteroscopy and biopsy

Question 10

How is endometrial cancer staged?

Answer 10

Histology

Question 11

56 year old woman with endometrial thickness > 10mm. What would you do if she is symptomatic or asymptomatic?

Answer 11

Symptomatic: 2 WW referral
Asymptomatic: Urgent hysteroscopy

Question 12

What investigation to assess lymph node involvement in metastatic endometrial cancer?

What can be used to determine staging?

Answer 12

MRI pelvis

CT chest/abdomen/pelvis

Question 13

What treatments can be done for endometrial cancer?

Answer 13

Total abdominal hysterectomy and bilateral salpingo-oopherectomy and pelvic washings

Pelvic lymphadenectomy

Adjuvant radiotherapy

External beam therapy –> reduce bleeding