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O&G > Endometrial hyperplasia and endometrial cancer > Flashcards

Endometrial hyperplasia and endometrial cancer Flashcards

1
Q

What are the causes of endometrial hyperplasia?

A

Increased oestrogen stimulation leads to excessive proliferation of the endometrium, e.g. in:

  • follicle persistence in anovulatory cycles
  • PCOS
  • granulosa cell tumours
  • HRT without progestin administration
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2
Q

What is the difference in risk of carcinoma between endometrial hyperplasia without atypia and endometrial hyperplasia with atypia?

A

Without atypia:
- Risk is ~1-3%

With atypia:

  • Very high risk
  • Up to 40% of cases have co-existing invasive endometrial carcinoma
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3
Q

What are the clinical features of endometrial hyperplasia?

A

Abnormal vaginal bleeding –> intermenstrual, postmenopausal, post-coital, or constant bleeding)

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4
Q

What is the 1st investigation done when endometrial hyperplasia is suspected?

A

TVUS to assess endometrial thickening

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5
Q

What is an abnormal endometrial thickness in premenopausal women?

A

> 1.5cm

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6
Q

What is an abnormal endometrial thickness in postmenopausal women?

A

> 4-5cm

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7
Q

How is endometrial hyperplasia without atypia usually managed?

A
  • High-dose progestogens with repeat sampling every 3-4 months
  • IUS (Mirena) - mainly for women with PCOS
  • Regular TVUS
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8
Q

How is endometrial hyperplasia with atypia in women with wishes to conceive usually managed?

A
  • Progestin therapy

- Close surveillance with regular endometrial sampling

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9
Q

How is endometrial hyperplasia with atypia in women with wishes no conceive usually managed?

A
  • Total abdominal hysterectomy with or without bilateral salpingo-oophorectomy
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10
Q

How is endometrial hyperplasia with atypia in post-menopausal women usually managed?

A
  • Total abdominal hysterectomy with bilateral salpingo-oophorectomy
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11
Q

What type of cancer is endometrial cancer?

A

> 90% are adenocarcinomas

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12
Q

What are the features of type 1 endometrial cancer?

A
  • Low-grade endometrioid cancer
  • Oestrogen sensitive
  • Less aggressive
  • Associated with obesity
  • Often have atypia as a precursor
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13
Q

What are the features of type 2 endometrial cancer?

A
  • High-grade endometrioid, clear cell, serous, or mucinous cancers
  • Not oestrogen sensitive
  • More aggressive
  • Tend not to be related to obesity
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14
Q

What are the risk factors for endometrial cancer?

A
  • Obesity
  • Diabetes
  • Early age at menarche
  • Late-onset menopause
  • Older age <>55 years)
  • Unopposed oestrogen HRT
  • Tamoxifen
  • Nulliparity
  • PCOS
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15
Q

What are protective factors against endometrial cancer?

A
  • COCP use

- Pregnancy/multiparity

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16
Q

What are the clinical features of endometrial cancer?

A

Postmenopausal:
- Any vaginal bleeding

Peri/Premenopausal:
- Abnormal PV bleeding (IMB, PCB, menorrhagia, etc)

  • Later stages may present with pelvic pain
  • Pelvic exam is often normal
17
Q

What investigations should be done if endometrial cancer is suspected?

A
  • TVUS (1st line)
  • Hysteroscopy ± endometrial biopsy
  • FBC, U&Es, blood glucose, clotting screen, ECG etc
18
Q

Describe stage 1 endometrial cancer.

A

1a: endometrium only
1b: <1/2 of myometrium
1c: >1/2 of myometrium

19
Q

Describe stage 2 endometrial cancer.

A

2a: Cervical glands
2b: Cervical stroma

**i.e. within the cervix, but not beyond the uterus

20
Q

Describe stage 3 endometrial cancer.

A

3a: invades uterine serosa/adnexae
3b: vaginal and/or parametrial involvement
3c: lymph node involvement

21
Q

Describe stage 4 endometrial cancer.

A

Metastases - bowel or bladder

22
Q

What is the surgical management of endometrial cancer?

A

Total hysterectomy and bilateral salpingo-oophorectomy

23
Q

What is the non-surgical management of endometrial cancer?

A
  • Progestins - esp if fertility wishes

- Radiotherapy and/or chemotherapy (adjuvant or palliative)

O&G (17 decks)

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