Endometrial Pathology and Endometrial Cancer Flashcards
What is used to measure endometrial thickness?
Transvaginal ultrasound
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?
Transvaginal ultrasound to measure endometrial thickness
What is done if the endometrium is >4mm thick or looks irregular?
Endometrial biopsy
During which procedure may a uterine polyp be removed?
Hysteroscopy
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?
Histological type- type of tumour
Histological grade- how aggressive the tumour is
Stage
Any lymph node involvement
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?
Endometrial adenocarcinoma
->by far the commonest
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?
Uterine serous & clear cell carcinoma
->high grade, more aggressive, worse prognosis
What are endometrial adenocarcinomas (type 1) asscoaited with?
Unopposed oestrogen
->oestrogen dominance where the body does not produce enough progesterone
What is a risk factor for developing endometrial adenocarcinoma (type 1)?
Obesity
Which age group are more likely to get uterine serous or clear cell carcinomas (type 2)?
Older women
Looking at pathology, what is a precursor for endometrial adenocarcinoma (type 1)?
Hyperplasia with atypia
Looking at pathology, what is a precursor for uterine serous and clear cell carcinoma (type 2)?
Serous intraepithelial precursor
Which investigation may be used to stage endometrial cancer aside from pathology e.g. microsopcy?
MRI
->allows staging based on depth of myometrial involvement, cervical involvement and lymph node involvement
What is the name pf the staging system of endometrial cancer?
FIGO staging system
-> includes stage 1A, 1B, 2, 3A, 3B, 3C, 4
What is the difference between FIGO staging of 1A and 1B?
1A- inner half of myometrium
1B- outer half of myometrium
What is meant by FIGO staging of 2?
Invades the cervix
What is meant by FIGO staging of 3A?
Tumour invading into serosa/adnexa
What is meant by FIGO staging of 3B?
Involvement of pelvic or para-aortic lymph nodes
What is meant by FIGO staging of 4?
Involvement of bladder/bowel/intra-abdominal/inguinal nodes
Treatment if early stage endometrial stage cancer?
Surgery- hysterectomy and bilateral salpingo-oophrorectomy
Treatment for endometrial cancer if there is high risk histology?
Chemotherapy
Treatment for advanced stage endometrial cancer?
Radiotherapy
Palliative treatment for endometrial cancer?
Progesterone
When does endometrial cancer tend to occur?
Post-menopausal women
Those with high oestrogen levels (obesity, polycystic ovarian syndrome, late menopause/early menarche)
If you are prescribing HRT, what must be prescribed alongside to protect the uterus?
Progesterone
->only in patients who have a uterus, some may of had it removed
Which familial syndromes can increases risks of endometrial cancer?
HNPCC
Lynch syndrome
Endometrial cancer symptoms?
Abnormal vaginal bleeding
Post menopausal bleeding
List some of the causes of post-menopausal bleeding.
Endometrial cancer
HRT
Peri-menopausal bleeding
Atrophic vaginitis
Cervical/endometrial polyps
Other cancer e.g. cervix, vulva, bladder, anal
How is a diagnosis of endometrial cancer made?
Histology of endometrium collected by biopsy
Main treatment of endometrial cancer?
Removal of tubes and ovaries and peritoneal washings
