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Obs & Gyn > Endometrial oncology > Flashcards

Endometrial oncology Flashcards

1
Q

define the endometrium

A

lining of the uterus

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2
Q

what accounts for around 80% of endometrial cancers

A

adenocarcinomas

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3
Q

what is the importance of adenocarcinoma endometrial cancers

A

oestrogen dependent cancer

meaning oestrogen stimulates the growth of endometrial cancer cells

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4
Q

women presenting with psotmenopausal bleeeding -
what is indicated

A

endometrial cancer until proven otherwise

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5
Q

key risk factors for endometrial cancer 2

A

obesity

diabetes

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6
Q

precancerous endometrial condition

A

endometrial hyperplasia

-involves thickening of the endometrium

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7
Q

most common gynaecological cancer

A

endometrial cancer

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8
Q

presenation of endometrial cancer 5

A

postmenopaual bleeding (PMB)

post coital bleeding -PCB

intermenstural bleeding - IMB

altered menstrual pattern

persistent vaginal discharge

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9
Q

types of endometrial cancer 3

A

adenocarcinoma 80%

sarcoma
-derived from muscel layer
-leiomyosarcoma

uterine carcinosarcoma

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10
Q

types of adenocarcinoma endometrial ca 2

A

type 1- oestroegn excess (most common)- endometroid
-grade I-III

type 2
non oestorgen excesses
-papillary serous
-clear cell

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11
Q

most common sarcoma endometrial canecr

A

leiomyosarcoma

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12
Q

what happens with patients with endometrial hyperpalasia

A

most return to normal
<5% go on to become endometrial ca

*RFs, presentation and Ix similar to endometrial cancer

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13
Q

types of endometrial hyperplasia 3
-% risk of malignnacy with each

A

hyperplasia without atypia - 1-3% malginancy risk

atypical hyperplasia 23% malignancy risk

*complex hyperplasia (both) - 3-4% malignaacny risk

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14
Q

how is endometrial hyperplasia treated

A

progesterone by a specialist

-either
-intrauterine system- merina coil

continuous oral progestogens
-medroxyprogesterone
or
-levonorgestrel

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15
Q

what dictates all the risk factors for endometrial cancer

A

unopposed oestrogen
-refers to oestrogen without progesterone

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16
Q

define unopposed oestrogen

A

refers to oestrogen wihtout progesterone

sitmualtes teh endometrial cells adn increases the risk of endometrial hyperpasia and cancer

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17
Q

risk factors for endometrial cancer 8

A

increased age
earlier onset of menstruation
late menopauasa

oestroegen only hormone replacement therapy

low or no pregnnacies

obesity

PCOS

tamoxifen

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18
Q

give an overview of the basic pathophys of PCOS ptx risk with endomeriral cancer

A

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.

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19
Q

for endometrial protection what should women with PCOS be prescribed 3

A

combined contraceptive pill- can also help with hirsutism and acne

intrauterine system - mirence coil

cyclical progesteogens
-induce withdrawal bleed

20
Q

why is obesity a crucial risk factor for endometrial cancer

A

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.

21
Q

why does tamoxifen increase the risk of endometrial cancer

A

although it has an anti-oestrogenic effect on breast tissue it has an oestrgenic effect on the endometrium-> increase the risk fo endometrial cancer

22
Q

risk factors for endometrial cancer not related to unopposed oestrogen

A

type 2 diabetes

HNPCC or lynch syndrome

23
Q

why does T2DM increase enometrial cancer risk

A

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.

24
Q

how does the affect of PCOS on insulin also increase endometrial cancer risk

A

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.

25
Q

protective factors for endometrial cancer 4

A

combined contraceptive pill

mirena coil

increased pregnancies

ciagrette smoking

26
Q

what is the referral criteria for endometrial cancer for a 2 week wait

A

postmenopausal bleeding
-MORE THAN 12 months after last menstural period

27
Q

what symptoms of would prompt what investiagion in women over 55 with suspected endometrial cancer

A

if they have:
=unexplaiend vaginal discahrge
-visible haematuria

referred for transvaginal ultrasound

28
Q

main investigaions for endometrial cancer 3

A

transvaginal ultrasound
-for endometrial thickness

pipelle biopsy
-highly sensitive for endometrial cancer so useful for excluding cancer

hystersocpy with endometrial biopsy

29
Q

what value on transvaginal ultrasound show a normal endometrial thickness =post menopause

A

normal is less than 4mm

30
Q

which investigaitons findings are sufficeint to demonstrate a low risk of endometrial cancer 2

A

normal trasnvgainal ultrasound - <4mm endometrial thickness

normal pipelle biopsy

31
Q

regarding the staging of endometrial cancer
-define stage 1

A

confined to uterus

32
Q

regarding the staging of endometrial cancer
-define stage 2

A

invades cervix

33
Q

regarding the staging of endometrial cancer
-define stage 3

A

invades ovaries, falloian tubes, vagina or lymph nodes

34
Q

regarding the staging of endometrial cancer
-define stage 4

A

invades bladder, rectum or beyond the pelvis

35
Q

usual treatment for stage 1 and 2 endometrial cancer 2

A

total abdominal hysterectomy with bilateral salpingo-oophorectomy

-also known as TAH and BSO

this is the removal of uterix,cervix and adnexa)

36
Q

other treatment options for endometrial cancer 4

A

radical hysterectomy and removal of pelvix lymph nodes, surrounding tissues and top of vagina
radiotherapy

chemotherapy

progesterone
-can be used as hormone treatment to slow progression of the cancer

37
Q

how is HNPCC differnet from APC (adenomatous polypossi coli)/ FAP- familial adenomatous polyposis

A

APC is numerous bening polyps in colon from early life

38
Q

state the two types of HNPCC

A

lynch I syndrome

lynch II syndrome

39
Q

define lynch I syndrome HNPCC

A

site-specific colorectal cancer

40
Q

define lynch II syndrome HNPCC

A

autosomal dominant

-predisposition to colorectal, endometrial, ovarian, stomach, hepatobiliary, brain, skin, upper urinary tract and small bowel cancers

MAINLY COLON AND ENDOMETRIUM

41
Q

what criteria is used for lynch II HNPCC

A

amsterdam criteria

diagnosed if:
colorectal cancer in 3 or more relatives
involves at least 2 generations
one case before age 50
familial polyposis excluded

42
Q

when is a pipelle biopsy indicated based on endometrial thickness

-2 scenarios

also what is the investigation of choice for tamoxifen users

A

if non-HRT and CC-HRT users
-biopsy if ET>3mm

if sequential HRT users
-biospy if ET>5mm

*hysterosocpy/biopsy in tamoxifen users

43
Q

managment of advanced endometrial cancer

A

MDT
-consider surgery, chemo, radiotherapy, hormonal

consider NACT in individual cases
-guided by patients co-morbitites and wishes

44
Q

mangemtn of inoperable endometrial cancer

A

ER/PR status of tumour importnat

chemo, radiotherapy, hormonal
-*depends on patients performance status

palliatve medicine input

single fraction of radiotherpay if heavy bleeding

45
Q

what guides post op radiotherapy in high risk endometrial caenr

A

MDT

clinical trials

ptx histopathollgical risk factors and performance status

46
Q

type of radioterhapy used in endometrial caner 2

A

external beam

brachytherapy

47
Q

side effects of radiotherapy in endometrial caner 4

A

proctits

cystitis

lethargy

skin chanegs

Obs & Gyn (23 decks)

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