Endometrial Pathology Flashcards
What are the investigations for post-menopausal women?
Trans-vaginal US - measure endometrial thickness, look at endometrial contour and biopsy if more than 4mm
Endometrial biopsy - pipelle or hysteroscopy
What is the surgical treatment for endometrial malignancy?
Total laparoscopic hysterectomy
Bilateral salpingoophorectomy
What are pathological prognostic features for endometrial malignancy?
Histological type
Histological grade
Stage
Lymphovascular space invasion (LVSI)
How is histological type of tumour determined?
Microscopy and possible ancillary tests
Grade is microscopy
How is stage of the endometrial malignancy determined?
How far the tumour has spread
Based on surgical resection with assessment of entire uterus and adjacent organs
How is lymphovascular space invasion determined?
Microscopy of resection specimen
What is type 1 endometrial cancer?
Endometrioid adenocarcinoma
Most common
Unopposed oestrogen
Hyperplasia with atypia precursor
What is type 2 endometrial cancer?
Uterine serous and clear cell carcinoma
High grade, more aggressive and worse prognosis
Generally older women
Serous intraepithelial carcinoma precursor
What investigations are used for endometrial cancer staging?
Surgical/ pathological
MRI - depth of myometrial invasion, cervical involvement and lymph node involvement
Describe the endometrial cancer staging
FIGO staging
1-4
1A is inner half myometrium and B is outer
4 - bladder/ bowel/ intra-abdominal/ inguinal nodes
What is the early stage treatment for endometrial cancer?
Surgery TAH/ BSO/ washings
What is the treatment for high risk histology in endometrial cancer?
Chemotherapy
What is the treatment for advanced stage endometrial cancer?
Radiotherapy
What is the management for palliation in in endometrial cancer?
Progesterone
Describe some features of endometrial cancer
Post-menopausal women
High circulating oestrogen levels
Endometrial hyperplasia with atypia
HNPCC/ Lynch type 11 familial cancer syndrome
What are some causes of high circulating oestrogen levels?
Obesity
Unopposed E2 therapy/ Tamoxifen
Polycystic ovarian syndrome (PCOS)
Early menarche/ late menopause
What are the main endometrial cancer symptoms?
Abnormal vaginal bleeding
Post menopausal bleeding (PMB)
What are causes of post-menopausal bleeding?
Endometrial cancer
HRT
Peri-menopausal bleeding
Atrophic vaginitis
Polyps cervical/ endometrial
Other cancers - cervix, vulva, bladder and anal
