Gynaecological Oncology & Screening - Endometrial Cancer

Question 1

What is Endometrial Cancer?

Answer 1

Cancer of the lining of the uterus - endometrium.

Question 2

Types of Endometrial Cancer.

Answer 2

1. 80% - Adenocarcinoma.

Question 3

Risk Factors of Endometrial Cancer (7).

Answer 3

Exposure to Unopposed Oestrogen :

1. Increased Age.
2. Earlier Menarche and Late Menopause.
3. Oestrogen-Only HRT.
4. No/Fewer Pregnancies.
5. Obesity.
6. PCOS.
7. Tamoxifen.
   * . Type II Diabetes.
   * *. HNPCC/Lynch Syndrome.

Question 4

Why is Tamoxifen a risk factor?

Answer 4

Anti-Oestrogenic effects on breast tissue but Oestrogen effect on endometrial tissue.

Question 5

Why is Type II Diabetes a risk factor?

Answer 5

Increased production of Insulin - insulin can stimulate endometrial cells (hyperplasia).

Question 6

Why is PCOS a risk factor? (2)

Answer 6

1. Association with Insulin Resistance and increased Insulin production.
2. Lack of Ovulation (so no Corpus Luteum and Progesterone).

Question 7

What is offered to PCOS patients for endometrial protection? (3)

Answer 7

1. COCP.
2. IUS.
3. Cyclical Progestogens (Withdrawal Bleed Induce).

Question 8

Why is Obesity a risk factor? (2)

Answer 8

1. Adipose tissue is a source of Oestrogen (main source in postmenopausal women).
2. Adipose Tissue contains Aromatase (converts Androgens from adrenal glands into Oestrogen).

Question 9

Pathophysiology of Endometrial Cancer.

Answer 9

1. Oestrogen-Dependent (growth of endometrial cancer cells is dependent on Oestrogen).

Question 10

Protective Factors of Endometrial Cancer.

Answer 10

1. Smoking (Anti-Oestrogenic).
2. COCP.
3. IUS Coil.
4. Increased Pregnancies.

Question 11

Why is Smoking anti-Oestrogenic? (3)

Answer 11

1. Different metabolism in smokers.
2. Leaner - less Adipose tissue.
3. Destruction of Oocytes.

Question 12

What is Endometrial Hyperplasia?

Answer 12

Precancerous condition involving thickening of the endometrium - abnormal proliferation in excess of the normal proliferation.

Question 13

Types of Endometrial Hyperplasia (2).

Answer 13

1. Hyperplasia without Atypia.

2. Atypical Hyperplasia.

Question 14

Risk Factors, Presentation and Investigations of Endometrial Hyperplasia.

Answer 14

Similar to Endometrial Cancer.

Question 15

Management of Endometrial Hyperplasia.

Answer 15

Progestogens e.g. IUS or Continuous Oral Progestogens e.g. MDP, Levonorgestrel.

Question 16

Clinical Presentation of Endometrial Cancer (5).

Answer 16

1. Postmenopausal Bleeding.
2. Postcoital Bleeding, Intermenstrual Bleeding, Menorrhagia.
3. Abnormal Vaginal Discharge.
4. Haematuria.
5. Anaemia and Thrombocytosis.

Question 17

Rule of Thumb of Endometrial Cancer.

Answer 17

Any woman presenting with postmenopausal bleeding is Endometrial Cancer until proven otherwise.

Question 18

NICE recommendations with Endometrial Cancer (2).

Answer 18

1. 2 Week Wait - Postmenopausal Bleeding.

2. TVUS in Women 55+ if Unexplained Vaginal Discharge or Visible Haematuria + Thrombocytosis, Anaemia or Hyperglycaemia.

Question 19

Investigations of Endometrial Cancer (3).

Answer 19

1. Transvaginal US - Endometrial Thickness (should be less than 4mm in post-menopausal women).
2. Pipelle Biopsy (Sensitive for Endometrial Cancer).
3. Hysteroscopy (Endometrial Biopsy).

Question 20

What is a Pipelle Biopsy?

Answer 20

Speculum examination and filling of a pipelle that is inserted through the cervix (thin tube) of endometrial tissue.

Question 21

Staging of Endometrial Cancer (4).

Answer 21

FIGO :

1. Confined to Uterus.
2. Invades Cervix.
3. Invades Ovaries, Fallopian Tubes, Vagina, Lymph Nodes.
4. Invades Bladder, Rectum or Beyond Pelvis.

Question 22

Management of Endometrial Cancer (4).

Answer 22

1. Stage I/II : Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH+BSO).
2. Radical Hysterectomy (pelvic lymph nodes + surrounding tissues + top of vagina).
3. Radiotherapy/Chemotherapy.
4. Progesterone - Hormonal Treatment to slow Progression.