Endometrial Pathology and Endometrial Cancer

Question 1

What is used to measure endometrial thickness?

Answer 1

Transvaginal ultrasound

Question 2

A post-menopausal woman sees you with vaginal bleeding.
Her last period was ten years ago.
She has no abdominal pain.
She has no bowel/urinary symptoms.
Which investigation would you want to refer for?

Answer 2

Transvaginal ultrasound to measure endometrial thickness

Question 3

What is done if the endometrium is >4mm thick or looks irregular?

Answer 3

Endometrial biopsy

Question 4

During which procedure may a uterine polyp be removed?

Answer 4

Hysteroscopy

Question 5

Pathology is used to diagnose and make recommendations for treatment/management and come up with a prognosis.

What are some of the prognostic features included in the pathological report?

Answer 5

Histological type- type of tumour
Histological grade- how aggressive the tumour is
Stage
Any lymph node involvement

Question 6

There are quite a few different types of endometrial tumour but they can be classified more broadly as being type 1 or type 2.

What kind of tumour is type 1?

Answer 6

Endometrial adenocarcinoma

->by far the commonest

Question 7

There are quite a few different types of endometrial tumour but they can be classified more broadly as being type 1 or type 2.

What kind of tumour is type 2?

Answer 7

Uterine serous & clear cell carcinoma

->high grade, more aggressive, worse prognosis

Question 8

What are endometrial adenocarcinomas (type 1) asscoaited with?

Answer 8

Unopposed oestrogen

->oestrogen dominance where the body does not produce enough progesterone

Question 9

What is a risk factor for developing endometrial adenocarcinoma (type 1)?

Answer 9

Obesity

Question 10

Which age group are more likely to get uterine serous or clear cell carcinomas (type 2)?

Answer 10

Older women

Question 11

Looking at pathology, what is a precursor for endometrial adenocarcinoma (type 1)?

Answer 11

Hyperplasia with atypia

Question 12

Looking at pathology, what is a precursor for uterine serous and clear cell carcinoma (type 2)?

Answer 12

Serous intraepithelial precursor

Question 13

Which investigation may be used to stage endometrial cancer aside from pathology e.g. microsopcy?

Answer 13

MRI

->allows staging based on depth of myometrial involvement, cervical involvement and lymph node involvement

Question 14

What is the name pf the staging system of endometrial cancer?

Answer 14

FIGO staging system

-> includes stage 1A, 1B, 2, 3A, 3B, 3C, 4

Question 15

What is the difference between FIGO staging of 1A and 1B?

Answer 15

1A- inner half of myometrium
1B- outer half of myometrium

Question 16

What is meant by FIGO staging of 2?

Answer 16

Invades the cervix

Question 17

What is meant by FIGO staging of 3A?

Answer 17

Tumour invading into serosa/adnexa

Question 18

What is meant by FIGO staging of 3B?

Answer 18

Involvement of pelvic or para-aortic lymph nodes

Question 19

What is meant by FIGO staging of 4?

Answer 19

Involvement of bladder/bowel/intra-abdominal/inguinal nodes

Question 20

Treatment if early stage endometrial stage cancer?

Answer 20

Surgery- hysterectomy and bilateral salpingo-oophrorectomy

Question 21

Treatment for endometrial cancer if there is high risk histology?

Answer 21

Chemotherapy

Question 22

Treatment for advanced stage endometrial cancer?

Answer 22

Radiotherapy

Question 23

Palliative treatment for endometrial cancer?

Answer 23

Progesterone

Question 24

When does endometrial cancer tend to occur?

Answer 24

Post-menopausal women
Those with high oestrogen levels (obesity, polycystic ovarian syndrome, late menopause/early menarche)

Question 25

If you are prescribing HRT, what must be prescribed alongside to protect the uterus?

Answer 25

Progesterone

->only in patients who have a uterus, some may of had it removed

Question 26

Which familial syndromes can increases risks of endometrial cancer?

Answer 26

HNPCC
Lynch syndrome

Question 27

Endometrial cancer symptoms?

Answer 27

Abnormal vaginal bleeding
Post menopausal bleeding

Question 28

List some of the causes of post-menopausal bleeding.

Answer 28

Endometrial cancer
HRT
Peri-menopausal bleeding
Atrophic vaginitis
Cervical/endometrial polyps
Other cancer e.g. cervix, vulva, bladder, anal

Question 29

How is a diagnosis of endometrial cancer made?

Answer 29

Histology of endometrium collected by biopsy

Question 30

Main treatment of endometrial cancer?

Answer 30

Removal of tubes and ovaries and peritoneal washings