Endometrial Pathology

Question 1

post-menopausal bleeding investigations

Answer 1

• pelvic and speculum exam
• transvaginal USS to measure endometrial thickness
• endometrial biopsy e.g. pipelle if thickness > 4mm or iregular
• hysteroscopy: can take biopsy and treat

Question 2

endometrial cancer treatment

Answer 2

Early stage:
- total laparoscopic hysterectomy (TLH)
- bilateral salpingoophorectomy (BSO)
- plus peritoneal washings

High risk histology:
- chemotherapy

Advanced Stage:
- Radiotherapy

Palliation:
- Progesterone

Question 3

describe endometrial cancer type 1

Answer 3

• endometrioid adenocarcinoma
• by far the commonest
• unopposed oestrogen
• hyperplasia with atypia precursor

Question 4

describe endometrial cancer type 2

Answer 4

• uterine serous & clear cell carcinoma
• high grade, more aggressive, worse prognosis
• generally older women
• serous intraepithelial carcinoma precursor

Question 5

endometrial cancer staging investigations

Answer 5

• Surgical/Pathological
• MRI: depth of myometrial invasion, cervical involvement, lymph node involvement

Question 6

endometrial cancer risk factors

Answer 6

• post-menopausal women
• high circulating oestrogen levels: obesity, unopposed E2 therapy/tamoxifen, PCOS, early menarche/late menopause
• endometrial hyperplasia with atypia
• HNPCC/Lynch type II familiar cancer syndrome

Question 7

endometrial cancer symptoms

Answer 7

• abnormal vaginal bleeding
• post-menopausal bleeding (PMB)

Question 8

list some potential causes of post-menopausal bleeding

Answer 8

• endometrial cancer in 8% of cases
• HRT
• peri-menopausal bleeding
• atrophic vaginitis
• polyps cervical/endometrial
• other cancers e.g. cervix, vulva, bladder, anal