Endometrial Carcinoma

Question 1

Prognosis

Answer 1

1. HISTOLOGICAL TYPE + GRADE
   
   2. STAGING = SURGICAL/PATHOLOGICAL, MRI
      a. MRI = DEPTH of MYMETRIAL INVASION, CERVICAL INVOLVEMENT, LYMPH NODE INVOLVEMENT - used pre-operatively to assess if high risk care/not
      
      3. LYMPHOVASCULAR SPACE INVOLVEMENT (LVSI) - predictor of LIKELIHOOD of SPREAD

Question 2

Presentation

Answer 2

ABNORMAL VAGINAL BLEEDING

POST-MENOPAUSAL BLEEDING (PMB) - RED FLAG (after 12 months of being bleed-free - bleed again)

	○ Only 8% of women w/ PMB have endometrial cancer

OTHER AETIOLOGY of PMB:

§ HRT

§ PERI-MENOPAUSAL BLEEDING - at MENOPAUSE, IRREGULAR PERIODS

§ ATROPHIC VAGINITIS, GU SYMPTOMS = LESS OESTROGEN, NON-INFECTIOUS INFLAMMATION, TISSUES MORE SUSCEPTIBLE to TRAUMA (e.g. post-coital bleeding), THINNER, DEHYDRATED CELLS

§ POLYPS CERVICAL/ENDOMETRIAL - would remove a polyps causing PMB, unlike in a pre-menopausal pt.

§ OTHER CANCER e.g. CERVIX, VULVA, BLADDER, ANAL = CHECK OTHER AREAS AS PT. MAY BE UNSURE of BLEEDING SOURCE

Question 3

Pathophysiology/risk factors

Answer 3

• POST-MENOPAUSAL WOMEN
  
  • HIGH CIRCULATING OESTROGEN LVLS = OBESITY, UNOPPOSED OESTROGEN THERAPY/TAMOXIFEN, PCOS, EARLY MENARCHE/LATE MENOPAUSE○ RELATED to HIGH CONTINUOUS LVL of OESTROGEN (MENSTRUATION = CYCLICAL LVLS) - tamoxifen, PCOS
  • ATYPICAL ENDOMETRIAL HYPERPLASIA (endometrial hyperplasia w/ atypia) - HYSTERCTOMY at this stage
  • HNPCC/LYNCH TYPE II FAMILIAL CANCER SYNDROME = BOWEL, BREAST, OVARIAN, ENDOMETRIAL CANCER

Question 4

Investigations/diagnosis

Answer 4

Transvaginal USS - looking for endometrial thickness (>4mm) or endometrial irregularity

Endometrial Biopsy - via pipelle - blind procedure

Hysteroscopy - can target area for biopsy, for pt. who cannot tolerate pipelle/need more info

Question 5

Management

Answer 5

MDT DISCUSSION

early stage = total abdominal hysterectomy + bilateral salpingo-oophorectomy + peritoneal washings

high risk histology = chemotherapy

advanced disease e.g. pelvic disease = RT

palliation = progesterone e.g. problems w/ heavy bleeding, cannot have hysterectomy, metastatic disease

Question 6

Epidemiology

Answer 6

75 - 79y/o - increasing incidence due to obesity + longer lifespans

Question 7

Types

Answer 7

Type 1 = endometrial adenocarcinoma - commonent + does well, unopposed oestrogen rx, often large & obese, endometrial hyperplasia w/ atypia - hysterectomy

Type 2 = uterine serous & clear cell carcinoma - older women, high grade + more aggressive + worse prognosis + metastasise early, serous intra-epithelial carcinoma pre-cursor

Question 8

Staging

Answer 8

1a = inner 1/2 of myometrium
1b = outer 1/2 of myometrium
2 = invades cervix
3a = serosa/adnexa
3b = vagina/parametrium
3c = pelvic/para-aortic nodes
4 = bladder/bowel/intra-abdominal/inguinal nodes