GTG Endometrial Hyperplasia Flashcards
Which is the most common gynaecological cancer in western countries?
Endometrial cancer
What is endometrial hyperplasia
Precancerous condition, irregular proliferation of the endometrial glands with increase in gland to stomal ratio.
Most common Sx of endometrial hyperplasia
HMB
IMB
Irregular/unscheduled bleeding on HRT
PMB
RF for endometrial hyperplasia
Unopposed oestrogen
- Increase BMI
- Anovulation
- Oestrogen secreting tumours (granulose cell tumour)
Drug induced endometrial stimulation (oestrogen replacement, tamoxifen)
+/- immunosuppression/infection
What % of negative Bx from outpatient sampling will have EH
2%
For PMB USS ET <4mm, what is the risk of cancer?
<1%
For premenopausal, if PCOS what cut of endometrial thickness is used for low risk of cancer?
7mm
Risk of endometrial hyperplasia without atypia progressing to endometrial cancer?
<5% over 20 years
What % of endometrial hyperplasia without atypia will regress with and without progesterone
Without 74%
With 90-96%
What is 1st line progesterone treatment for hyperplasia without atypia?
LNG-IUS - minimum 6 months, encourage to 5 years
If declines - medoxyprogesterone 10-20mg/day or
norethisterone 1–15mg/day - continuous
Chance of replapse with IUS and progesterones
IUS 12%
Progesterone 28%
For EH without atypia Tx with IUS, what FU is arranged?
Endometrial Bx every 6 months, must have 2 negatives in a row before discharge
What is risk of relapse of EH with BMI < 35 and >35 with IUS
<35 3%
>35 33%
If EH without atypia, treated with progesterones or BMI >35 what follow up should be arranged?
6 monthly Bx until 2 negative then every 12 month
If after 12 months there is no regresstion, what is the risk of cancer and what treatment should be offered>
23% will have cancer
Offer hysterectomy
With EH without atypia who should be offered hysterectomy?
Progression to atypia
No regression 12 months
Relapse of EH after completing progesterone
Persistent bleeding
Declines surveillance or not compliant with medical Tx
What % of women with endometrial hyperplsia with atypia have carcinoma?
43%
Should BSO be performed at hysterectomy?
Peri/Postmenopausal - yes
Premenopausal - consider risk of ovarian cancer vs surgical menopause
Risk of ovarian cancer is endometrial hyperplasia?
4%
If atypical hyperplasia and want to preserve fertility?
Pre-treatment Ix to rule out invasive endometrial cancer or ovarian cancer
MRI/CT/TVS/CA125
1st IUS
2nd PO progestone
Once fertility no longer required → hysterectomy
If atypical hyperplasia and not undergoing hysterectomy, what follow up should be arranged?
Endometrial biopsy every 3 months until 2 neg bx
If regression, FU every 6-12 months until hysterectomy
If no regression at 12 months, strongly recommend hysterectomy
For women who want to conceive, how many negative Bx before can try? What support?
1 negative Bx
Refer to fertility specialist, higer rates of hyperplasia
What is the live birth rate for women with endometrial hyperplasia receiving fertility treatment?
25%
What is the minimum amount of progesterone need for endometrial protection for women taking HRT with a uterus?
Norethisterone 1mg/day
Medroxyprogesterone 1.5mg/day
If EH on HRT what should be done?
If want to continue, if sequential → continuous or LNG IUD
If continus → consider stopping HRT/LNG IUD
What type of drugs is tamoifen
Selective oestrogen receptor modulator
Acts as partial agonist in vagina/uterus → fibroids, polyps, EH, cancer
Progression to cancer for atypical hyperplasia
25-30%
