Endometrial oncology Flashcards
define the endometrium
lining of the uterus
what accounts for around 80% of endometrial cancers
adenocarcinomas
what is the importance of adenocarcinoma endometrial cancers
oestrogen dependent cancer
meaning oestrogen stimulates the growth of endometrial cancer cells
women presenting with psotmenopausal bleeeding -
what is indicated
endometrial cancer until proven otherwise
key risk factors for endometrial cancer 2
obesity
diabetes
precancerous endometrial condition
endometrial hyperplasia
-involves thickening of the endometrium
most common gynaecological cancer
endometrial cancer
presenation of endometrial cancer 5
postmenopaual bleeding (PMB)
post coital bleeding -PCB
intermenstural bleeding - IMB
altered menstrual pattern
persistent vaginal discharge
types of endometrial cancer 3
adenocarcinoma 80%
sarcoma
-derived from muscel layer
-leiomyosarcoma
uterine carcinosarcoma
types of adenocarcinoma endometrial ca 2
type 1- oestroegn excess (most common)- endometroid
-grade I-III
type 2
non oestorgen excesses
-papillary serous
-clear cell
most common sarcoma endometrial canecr
leiomyosarcoma
what happens with patients with endometrial hyperpalasia
most return to normal
<5% go on to become endometrial ca
*RFs, presentation and Ix similar to endometrial cancer
types of endometrial hyperplasia 3
-% risk of malignnacy with each
hyperplasia without atypia - 1-3% malginancy risk
atypical hyperplasia 23% malignancy risk
*complex hyperplasia (both) - 3-4% malignaacny risk
how is endometrial hyperplasia treated
progesterone by a specialist
-either
-intrauterine system- merina coil
continuous oral progestogens
-medroxyprogesterone
or
-levonorgestrel
what dictates all the risk factors for endometrial cancer
unopposed oestrogen
-refers to oestrogen without progesterone
define unopposed oestrogen
refers to oestrogen wihtout progesterone
sitmualtes teh endometrial cells adn increases the risk of endometrial hyperpasia and cancer
risk factors for endometrial cancer 8
increased age
earlier onset of menstruation
late menopauasa
oestroegen only hormone replacement therapy
low or no pregnnacies
obesity
PCOS
tamoxifen
give an overview of the basic pathophys of PCOS ptx risk with endomeriral cancer
leads to increased exposure to unopposed oestrogen due to a lack of ovulation.
, when ovulation occurs, a corpus luteum is formed in the ovaries from the ruptured follicle that released the egg.
It is this corpus luteum that produces progesterone, providing endometrial protection during the luteal phase of the menstrual cycle (the second half of the menstrual cycle).
Women with polycystic ovarian syndrome are less likely to ovulate and form a corpus luteum. Without developing a corpus luteum during the menstrual cycle, progesterone is not produced, and the endometrial lining has more exposure to unopposed oestrogen.
for endometrial protection what should women with PCOS be prescribed 3
combined contraceptive pill- can also help with hirsutism and acne
intrauterine system - mirence coil
cyclical progesteogens
-induce withdrawal bleed
why is obesity a crucial risk factor for endometrial cancer
adipose tissue (fat) is a source of oestrogen
-it is the primary source of oestrogen in postmenopausal women
-contains aromatase an enzyme that converts andogens like testosterone to oestrogen
-this extra oestrogen is unopposed in women that are not ovulating (e.g. PCOS or postmenopause), because there is no corpus luteum to produce progesterone.
why does tamoxifen increase the risk of endometrial cancer
although it has an anti-oestrogenic effect on breast tissue it has an oestrgenic effect on the endometrium-> increase the risk fo endometrial cancer
risk factors for endometrial cancer not related to unopposed oestrogen
type 2 diabetes
HNPCC or lynch syndrome
why does T2DM increase enometrial cancer risk
Type 2 diabetes may increase the risk of endometrial cancer due to the increased production of insulin. Insulin may stimulate the endometrial cells and increase the risk of endometrial hyperplasia and cancer.
how does the affect of PCOS on insulin also increase endometrial cancer risk
PCOS is also associated with insulin resistance and increased insulin production. Insulin resistance further adds to the risk of endometrial cancer in women with PCOS.
