Endometrium Flashcards
epidemiology
age: increases in post menopausal women
sex at a young age increases chances
risk factors
long term unopposed oestrogen (not balanced by progesterone)
polycystic ovary syndrome: enlarged ovaries but with undeveloped follicles, no ovulation as no progesterone
infrequent or no menses can lead to weight gain, insulin imbalance and increased risk to type 2 diabetes
genetic factors: lynchs syndrome - hereditary non polyposis colorectal also uterine, kidney and stomach cancer
long term tamoxifen, risk links with duration, if used for five plus years they are three times more likely. Most likely to change to an aromatase inhibitor after have years [only given to post menopausal women]
presentation
PV bleeding
diagnosis
TVU: measures endometrium thickness, if >5mm = abnormal
pipette office sampling: endometrial biopsy
dilation + curettage: dilate and scrape the endometrium surface, pathological confirmation
staging
MRI
nodal involvement
distant mets
FIGO
what is the pathology
adenocarcinoma
what are the different types of adenocarcinoma
type 1 = excess oestrogen, grade 1or 2
type 2 = not linked with oestrogen, grade 3 (risk of recurrence)
includes clear cell carcinoma, serous carcinoma
what is stage I
confined within the endometrium
IA = with or <50% myometrium invasion
IB = with = or >50% myometrium invasion
what is stage II
spread to cervix not beyond the uterus
what is stage III
local or regional spread
IIIA = serous layer of uterus and/or UT/cervix/ ovary
IIIB = vagina and/or parametria
IIIC = mets to pelvic and/or para-aortic nodes
what is stage IV
invades bladder and/or bowel and/or distant mets
IVA = spread beyond the true pelvis or involvement of bladder or rectum
IVB = distant mets included intra-abdominal aorta and/or inguinal nodes
low risk
no adjuvant RT
intermediate risk
brachy, surveillance, is an option for over 60, polyp only
high/ intermediate risk
EBRT +/- VVBT
if no nodal staging or extensive lymph node vascular space invasion or stage III
VVBT if node negative, only consider chemo if no nodal staging + extensive LVSI
high risk
EBRT+ VVBT
chemo: carbo + paciltaxel
where is blood borne spread [choriocarcinoma]
early to the lungs, liver, CNS, also may involve skin, brain, bowel and spleen, bone mets are rare
presentation of choriocarcinoma
vaginal bleeding, pelvic discomfort
common to have met symptoms
OE: uterus will be larger, tender, pelvis mass will be palpable
indications for primary RT
rare
unsuitable for surgery
post op
stage III - EBRT + VVBT
mets disease, local or symptom control
what is management dependent on
risk status
how is stages I-II managed
TAH + BSO
adj therapy
+ VVBT reduces local recurrence rate, destroys any residual cells in cervix
EBRT + VVBT reserved for high risk
definitive RT for stages I-II =
intracavity BT + pelvic EBRT
how is stage III managed
surgical resection of all disease
adjuvant EBRT or VVBT
high risk may have chemorad
definitive RT = EBRT + ICBT where surgery isn’t possible
how is stage IV managed
palliative
surgery to reduce tumour volume (neoadjuvant chemo)
post-op adjuvant chemo (carbo + paciltaxel)
palliative EBRT for symptom control, pain and bleeding
what is choriocarcinoma
rare, haemorrhage tumour, arises in the uterus, derived from the placental tissue, which develop after a normal pregnancy
what are half off choriocarcinoma associated with
hydatidiform mole/ molar pregnancy (an abnormal cluster of cells from fertilisation of the sperm and egg, from which a foetus is unable to form)
where is this seen [c]
under 20s, pregnancies and over 40s
where can it occur [c]
ectopic pregnancies or as a tumour in the external geneitalia
what is the treatment [c]
suction evaluation of uterus
single or combo chemo dependent on risk and stage
prognosis [c]
even with high risk it shows good prognosis
