Endometrial Cardinoma

Question 1

What is endometrial carcinoma

Answer 1

Cancer of the Endometrium
Peak age of 65-70
Low mortality d/2 easy dg

Question 2

Genetic factors associated with endometrial carcinoma

Answer 2

Hereditary non polyposis colorectal cancer

Lynch 2 syndrome,e

Question 3

RF for endometrial Cancer

Answer 3

Obesity & DB
Polycystic ovarian syndrome
Atypical endometrial hyperplasia

Increased oestrogen exposure

• early menarche, late menopause
• nulliparity
• unopposed oestrogen therapy
• tamoxifen therapy

Question 4

Histology of endometrial cancer

Answer 4

1. Endometrial carcinoma 90%
   - endometrioid (60%)
   - adenocarcinoma
   - mixed
   - serous papillary — poor prog🤕
2. SCC
3. undifferentiated carcinoma

Question 5

Types of endometrial cancer according to oestrogen dependence

Answer 5

dependant (80%)

Non dependent has worse prognosis

Dependence is immjnohistochemically evaluated for oestrogen and progesterone

Question 6

Endometrial cancer spread

Answer 6

Locally into the peritoneal space

Lymphatic: pelvic and paraaortic LN

hematogenous: lung liver bone

Question 7

Staging of endometrial cancer

Answer 7

T
TX
T0
TIS

T1: confined to uterine body
A: limited to endometrium
B: 50% myometrial invasion
C: over 50% myometrial invasion

T2: invades cervix but doesn’t extend beyond uterus
A: involved endocervical glands
B: cervical storma invasion

T3: invades BEYOND UTERUS
A: serosal &/ adnexal invasion
B:vaginal involvement

T4: invasion of bladder&/bowel

Question 8

What is FIGO Staging

Answer 8

Shows the prognosis of endometrial cancer according to TNM stage

0=TIS 
1=T1
W
2=T2
3=T3
3c=T1-3 w/ Ln involvement 
4a=T4 regardless of LN 
4b= any T w/ metastasis

Question 9

Dg of endometrial cancer

Answer 9

LAB
cbc, esr, lover&renal rests, coag tests, urine analysis

Tumour markers to monitor course
CA 125
CEA

Biopsy for Histological confirmation via currettage

IMAGING

• US: transvag/ abdominal
• PET/CT for metastasis
• cystoscopy if infiltration suspected
• IV pyelography for parametrial invasion

Question 10

Principles of rx in endometrial cancer

Answer 10

Stage 1-3: radical surgery to cure 
#simple hysterectomy 
#complex hysterectomy (w/ Salpingoophorectomy)
#lymphadenectomy 

Stage 3b&4a: surgery plus chemo/radio (surgery alone isn’t enough to cure) 
#cystoreductive surgery 

State 4b: palliative chemotherapy

Question 11

Use of radiotherapy in endometrial cancer

Answer 11

Used I’m early stages w/ curative intent

Even used in inoperable cases

IMDT risk pts
Adjuvant radiotherapy
High risk pts
Adjuvant Per cut radiotherapy

Question 12

Systemic rx of endometrial cancer with endocrine and chemo therapy

Answer 12

Endometrial
1st line metastatic tumour w/ progesterone r’s MEDROXYPROGESTERONE ACETATE

Chemo
Local advanced or metastatic
CISPLATIN
Tumour shows Rapid resistance