Endometrial cancer (Complete) Flashcards
Definition endometrial cancer
Malignancy that originates from the endometrium, the inner lining of the uterus.
What is the clinical significance of endometrial cancer?
6th most common cancer in woman
15th most common cancer worldwide
What is the main aetiological cause of enodmetrial cancer?
Excess unoppososed oestrogen
(Increased proliferation of the glandular endometrial cells, –> greater gland:stroma ratio than is seen in normal endometrium)
What risk factors are associated with endometrial cancer?
Factors which can increase endogenous or exogenous exposure to oestrogen such as:
Obesity and T2DM
PCOS (Increase in androgens which can be converted into oestrogen, persistent follicles also produce oestrogen, low progesterone which opposes oestrogen)
Oestrogen-only HRT
Nulliparity (lack of pregnancy interruption)
Late menopause
Early menarche (Greater lifelong period of oestrogen)
Tamoxine therapy (Breast cancer treatment)
Lynch syndrome (HNPCC)
What are the three main ways PCOS can lead to increased oestrogen production?
Increased androgen production: Gets converted to oestrogen
Chronic annovulation: Ovarian follicles fail to mature and continuously releases oestrogen which doesnt follow hormonal cycle.
Imbalance in hormones: Decrease in progesterone which balanced oestrogen
Why is obesity associated with endometrial cancer?
Fat cells contain enzyme aromatase
Aromatase synthesises extra-ovarian oestrogen
Why are some breast cancer patients at risk of endometrial cancer?
Tamoxifen therapy is used in management of breast cancer and associated with endometrial cancer
What GI condition is associated with increased risk of endometrial cancer?
Lynch syndrome (Hereditary non-polyposis colon cancer/HNPCC)
N.B. Up to 40% will go on to develop endometrial cancer
What are some protective factors for endometrial cancer?
Regular exercise
Multiparity
Combined oral contraceptive pill use
Tobacco consumption (unclear as to why)
What is the most common form of endometrial cancer?
Adenocarcinoma
What are some of the main signs/symptoms of endometrial cancer?
Post-menopausal bleeding (90% cases)
Irregular or inter menstrual bleeding in premenopausal women.
Recent onset menorrhagia (heavy bleeding) especially in women >45 years of age
Abdominal discomfort/bloating
Anaemia
Weight loss
What examination should be performed in patients suspected of endometrial cancer? What are the subsequent findings?
Bi-manual pelvic examination
Uterine mass or enlarged uterus
A fixed uterus
Adnexal mass indicating extra-uterine disease
What examinations should be done for patients suspected of endometrial cancer?
Bedside:
Basic obs: Weight loss
Bloods:
FBC: Anaemia
Blood glucose: If patient obese/check for metabolic causes
Imaging:
Transvaginal ultrasound
Endometrial biopsy: Following suspicious ultrasound
CT chest abdomen and pelvis: If advanced disease suspected
Which presentations warrant 2-week cancer referral?
Any woman over 55 with post menopausal bleeding
What is the first-line investigation for endometrial cancer?
Transvaginal ultrasound
What findings on transvaginal ultrasound are indicative of endometrial cancer?
Abnormal thickening of endometrium
(>5mm = 96% probability of endometrial cancer)
Following transvaginal ultrasound findings, what investigation is diagnsotic for endometrial cancer?
Endometrial biopsy (Pipelle or hysteroscopy)
What alternative is offered if pipelle endometrial biopsy is contraindicted?
Hyesteroscopy
What is the management plan for patients diagnosed with endometrial cancer?
Surgery:
Total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy.
Medicine:
Radiotherapy and chemotherapy: Used in adjunt with surgey in patients with advanced disease
For elderly woman in which surgery is contraindicted, what alternative management options are available?
Progestogen therapy
What are some complications of management for patients with endometrial cancer?
Lymphoedema
Bladder instability (Bladder denervation)
Bowel and bladder fistulae
Vaginal stenosis (sexual dysfunction and makes future pelvic examinations difficult)
Early menopause
What differentials should be considered alongside endometrial cancer?
Uterine fibroids: Heavy menstrual bleeding, pelvic pressure or pain, frequent urination, constipation.
Endometrial polyps: Irregular menstrual bleeding, bleeding between menstrual periods, heavy menstrual periods, vaginal bleeding after menopause.
Cervical cancer: Abnormal vaginal bleeding, postmenopausal bleeding, and pelvic pain.
How does uterine fibroids differ to endometrial cancer?
Nature of bleeding:
Fibroids: Heavy irregular menstrual bleeding
Endometrial cancer: Post-menopausal bleeding
Pain: Uterine fibroids moresoe associated with pain and pressure whereas is a later presentation in endometrial cancer
Systemic symptoms: More common in endometrial cancer
How does endometrial polyps differ to endometrial cancer?
Bleeding pattern: Endometrial cancer more peristent and severe
Pain: Usually does not occur with endometrial polyps
Systemic symptoms: Occurs in endometrial cancer
How does cervical cancer differ to endometrial cancer?
Age: Endometrial more likely to affect middle-aged, post-menopausal woman
Bleeding pattern:
Endometrial: Post-menopausal bleeding
Cervical: Post-coital bleeding
Discharge: Cervical more associated with bloody, foul-smelling discharge
Pain: Cervical cancer moresoe dyspareunia and bladder symptoms
