Endometrial cancer diagnosis and management Flashcards
What are the risk factors for endometrial cancer ?
- Obesity
- Nulliparity - as having a kid provides a protective period of time from oestrogen reducing the chances of endometrial cancer development
- Late menopause so incresed oestrogen exposure throughout life
- Oestrogens excessive exposure - HRT and Tamoxifen, no pregnancies
- Pelvic irradiation
- Genetic e.g. Polycystic ovaries, lynch syndrome
What is the main presenting feature suggesting endometrial cancer ?
Postmenopausal bleeding (PMB)
How is endometrial cancer diagnosed ?
- 1st - Uterine transvaginal US may be suggestive if increased thickness seen
- 2nd for absolute diagnosis = by uterine sampling via hysteroscopy or curretage
Describe the staging for endometrial cancer
FIGO staging:
- Stage I - confined to uterus
- Stage II - Tumour invades cervix
- Stage III - Local or regional tumour spread e.g. uterus, vagina
- Stage IV - invades bladder, and or bowel and or distant metastases
What is the mainstay management of endometrial cancers?
Surgical management - TAH BSO + post-op radiotherapy
dont do lymphadenectomy in stage I & II but do it in stages above this
TAH BSO = radical hysterectomy + bilateral salpingo-oophrectomy
Radiotherapy can be given as external beam or brachytherapy (internal) when would one be used over the other ?
- Stage I to II generally use brachytherapy
- Stage III to IV generally use external beam radiotherapy
Chemo is sometimes given post-op too but it only provides a small increased benefit and remember is toxic so not often used
What are the 2 main types of endometrial cancers and what are their precursor lesions and assoicated mutations ?
Type 1:
- Endometrioid endometrial adenocarcinoma
- Precursor is atypical hyperplasia
- Associated with PTEN, KRAS, PIK3CA mutations
- Accounts for 80% of endometrical carcinomas
Type 2:
- Serous endometrial adenocarcinoma
- Precursor serous intraepithelial carcinoma
- Associated with TP53 mutation
- Accounts for 20%
