Endometrium

Question 1

epidemiology

Answer 1

age: increases in post menopausal women
sex at a young age increases chances

Question 2

risk factors

Answer 2

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]

Question 3

presentation

Answer 3

PV bleeding

Question 4

diagnosis

Answer 4

TVU: measures endometrium thickness, if >5mm = abnormal
pipette office sampling: endometrial biopsy
dilation + curettage: dilate and scrape the endometrium surface, pathological confirmation

Question 5

staging

Answer 5

MRI
nodal involvement
distant mets
FIGO

Question 6

what is the pathology

Answer 6

adenocarcinoma

Question 7

what are the different types of adenocarcinoma

Answer 7

type 1 = excess oestrogen, grade 1or 2
type 2 = not linked with oestrogen, grade 3 (risk of recurrence)

includes clear cell carcinoma, serous carcinoma

Question 8

what is stage I

Answer 8

confined within the endometrium
IA = with or <50% myometrium invasion
IB = with = or >50% myometrium invasion

Question 9

what is stage II

Answer 9

spread to cervix not beyond the uterus

Question 10

what is stage III

Answer 10

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

Question 11

what is stage IV

Answer 11

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

Question 12

low risk

Answer 12

no adjuvant RT

Question 13

intermediate risk

Answer 13

brachy, surveillance, is an option for over 60, polyp only

Question 14

high/ intermediate risk

Answer 14

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

Question 15

high risk

Answer 15

EBRT+ VVBT
chemo: carbo + paciltaxel

Question 16

where is blood borne spread [choriocarcinoma]

Answer 16

early to the lungs, liver, CNS, also may involve skin, brain, bowel and spleen, bone mets are rare

Question 17

presentation of choriocarcinoma

Answer 17

vaginal bleeding, pelvic discomfort
common to have met symptoms
OE: uterus will be larger, tender, pelvis mass will be palpable

Question 18

indications for primary RT

Answer 18

rare
unsuitable for surgery
post op
stage III - EBRT + VVBT
mets disease, local or symptom control

Question 19

what is management dependent on

Answer 19

risk status

Question 20

how is stages I-II managed

Answer 20

TAH + BSO
adj therapy
+ VVBT reduces local recurrence rate, destroys any residual cells in cervix
EBRT + VVBT reserved for high risk

Question 21

definitive RT for stages I-II =

Answer 21

intracavity BT + pelvic EBRT

Question 22

how is stage III managed

Answer 22

surgical resection of all disease
adjuvant EBRT or VVBT
high risk may have chemorad

definitive RT = EBRT + ICBT where surgery isn’t possible

Question 23

how is stage IV managed

Answer 23

palliative
surgery to reduce tumour volume (neoadjuvant chemo)
post-op adjuvant chemo (carbo + paciltaxel)
palliative EBRT for symptom control, pain and bleeding

Question 24

what is choriocarcinoma

Answer 24

rare, haemorrhage tumour, arises in the uterus, derived from the placental tissue, which develop after a normal pregnancy

Question 25

what are half off choriocarcinoma associated with

Answer 25

hydatidiform mole/ molar pregnancy (an abnormal cluster of cells from fertilisation of the sperm and egg, from which a foetus is unable to form)

Question 26

where is this seen [c]

Answer 26

under 20s, pregnancies and over 40s

Question 27

where can it occur [c]

Answer 27

ectopic pregnancies or as a tumour in the external geneitalia

Question 28

what is the treatment [c]

Answer 28

suction evaluation of uterus
single or combo chemo dependent on risk and stage

Question 29

prognosis [c]

Answer 29

even with high risk it shows good prognosis