Endometrial cancer

Question 1

What percentage of endometrial cancer cases occur before menopause?

Answer 1

25%

Question 2

Risk factors for endometrial cancer?

Answer 2

Anything which increases endometrial lining shredding and others

• obesity
• nulliparity
• early menarche
• late menopause
• unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously
• diabetes mellitus
• tamoxifen
• polycystic ovarian syndrome
• hereditary non-polyposis colorectal carcinoma

Question 3

What is the classic symptom?

Answer 3

Postmenopausal bleeding

Question 4

What other symptoms can occur?

Answer 4

• premenopausal women may have a change intermenstrual bleeding
• pain and discharge are unusual features

Question 5

When should a patient be referred using the suspected cancer pathway?

Answer 5

If the women is >=55 years and presents with postmenopausal bleeding

Question 6

First-line investigation?

Answer 6

Trans-vaginal ultrasound. A normal endometrial thickness (<4mm) has a high negative prediction value.

Question 7

What further investigation can be performed?

Answer 7

Hysteroscopy with endometrial biopsy

Question 8

Management for localised disease?

Answer 8

Total abdominal hysterectomy with bilateral salpingo-oophorectomy

Question 9

Management for high-risk disease?

Answer 9

Total abdominal hysterectomy with bilateral salpingo-oophorectomy. These patients may also have post-operative radiotherapy.

Question 10

What management is used for frail elderly women not considered suitable for surgery?

Answer 10

Progestogen therapy

Question 11

What are protective factors for endometrial cancer?

Answer 11

The combined oral contraceptive pill and smoking are protective.