Endometrial Cancer and Post-menopausal bleeding Flashcards
What is endomtrial cancer?
Oestrogen-dependent malignant neoplasm arising from the endometrium of the uterus
What is uterine cancer?
Any malignant neoplasm arising from the tissues of the body of the uterus, including the endometrium, myometrium and connective tissues
What is post-menopausal bleeding?
Vaginal bleeding occurring after 12 months of amenorrhoea in a woman of menopausal age or who has experienced the menopause – this affects 4-11% of postmenopausal women and accounts for 5% of all gynaecology outpatient referrals
At what age does endometrial cancer most commonly affect women?
>50s - rare under the age of 40
What are risk factors for the development of endometrial cancer?
-
Endogenous oestrogen exposure
- Early menarche/late menopause
- Delayed childbearing
- Nulliparity
- Obesity
- PCOS
- Diabetes/Metabolic syndrome
- Anovulatory menstrual cycle
- Oestrogen secreting tumours
- Exogenous oestrogen - HRT, tamoxifen
- HNPCC
- Breast cancer
What is thought to be the pathophysiological basis for endometrial cancer development?
Excessive oestrogen exposure with unapposed progesterone
What are protective factors for endometrial cancer?
- Parity
- OCP use
- Exercise
- Smoking
- Aspirin
- Drinking coffee
What are the main histological types of endometrial cancer?
- Endometroid
- Non-endometroid
- Uterine sarcomas
What is the most common type of endometroid carcinoma?
Endometroid adenocarcinoma
What proportion of endometrial cancers occur in post-menopausal women?
91%
What are uterine sarcomas
Tumours arising from the myometrium and connective tissues of the uterus
What are the main types of uterine sarcomas?
- Leiomyosarcoma
- Carcinosarcoma
- Endometrial stromal carcinoma
- Fibrosarcoma
- Adenosarcoma
- Metastases
What are the main types of non-endometroid endometrial cancers?
- Serous carcinoma
- Clear cell carcinoma
- Mixed adenocarcinoma
How does endometrial cancer tend to present symptomatically?
- Post-menopausal bleeding - profuse and persistent
- Pre-/perimenopausal - intermenstral bleeding/menorrhagia
- Pyometra
- Advanced disease - pelvic pain/mass, leg swelling, haematura, PR bleeding, weight loss, fatigue, symptoms of mets
What is pyometra?
Collection of pus in the uterine cavity
What signs might you see in someone with endometrial cancer?
Generally normal unless advanced:
- Pelvic mass
- Cancer in cervix - rare
- Enlarged, immobile uterus