Endometrial Carcinoma Flashcards
Risk factors
Unopposed estrogen
Obesity(stores estrogen) -Adipose tissue contains aromatase, which is an enzyme that converts androgens such as testosterone into oestrogen.
Nulliparity (no pregnancy )
Late menopause, early menarche
Oestrogen producing ovarian Tumors like granulosa theca cell malignancies
Family history
Ethnicity
Pcos- due to anovulatory cycles so no progesterone from corpus luteum
Tamoxifen(protects against breast ca but predispose to endometrial)
Caucasian
Post menopausal
P53 gene mutation
Hnpcc/lynch syndrome which is associated with gastric ca, colon ca l, ovarian ca
Diabetes and htn
What are the three types of endometrial hyperplasia
Cystic glandular
Adenomatous
Atypical
What is the most common type of endometrial hyperplasia and which is most aggresive(highest malignant potential)
Cystic glandular most common and least malignant potential
Atypical hyperplasia highest malignant potential
Other is adenomatous hyperplasia
Medical Tx of endometrial hyperplasia
Medroxyprogrsterone acetate
Mirena
Depo provera
What is the most common subtype of endometrial carcinoma and what’s the other
Endometroid Adenocarcinoma
Serous clear cell carcinoma
True or false uterine serous carcinoma is highly suggestive of carcinoma which resembles that of ovaries due to propensity for extra uterine spread
True
Presentation of endometrial ca
The number one presenting symptom of endometrial cancer to remember for your exams is postmenopausal bleeding.
Endometrial cancer may also present with:
Postcoital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count Lower abd pain
Protective factors for endometrial hyperplasia and carcinoma
Smoking
High parity
Cocp
Exercise
Treatment of 3 types endometrial hyperplasia
Cystic glandular: which is treated with oral progesterones
Adenomatous: treated with iud progesterone therapy
Atypical treatment depends on reproductive plans; post menopausal or completed childbearing then hysterectomy/bso… if not then medroxyprogesterone
Treatment is continued for up to 6 months then reevaluated with endometrial biopsy
How does serous clearl cell carcinoma come about
NOT ESTROGEN RELATED
due to p53 mutation
What are three endometrial sampling techniques and which is the gold standard
Endometrial pipelle (de Courniet) sampling
D&C- blind procedure so may miss pathology
Hysteroscopy and biopsy(gold standard)
What size endometrial thickness is classical for endometrial cancer on Transvaginal ultrasound
More than 4mm
Which has a poorer prognosis, endometrial carcinoma or endometrial sarcoma
Sarcoma
Type 2 endometrial carcinoma (serous clear cell carcinoma) have worse prognosis than endometrial Adenocarcinoma as well(serous ass with p53 mutation and rapid deep growth)
