Malignant Disease of the Uterus Flashcards
Suspect endometrial cancer Ix
TVUSS
?Hysteroscopy
?Staging
RF for Endometrial cancer
No. menstrual cycles PCOS Obesity FHx Br/Ovarian Ca. Endometrial hyperplasia
Protective factors against endometrial cancer
Interrupted cycles (Pregnancy, anovulation from contraception) Healthy lifestyle
TVUSS in endometrial cancer
Measures endometrial thickness
<4mm = unlikely cancer
>4mm requires hysteroscopic biopsy
Hysteroscopy for ?endometrial cancer
LA
OutPt if possible
GA if cervix stenosed or hysteroscopy poorly tolerated
Biopsy for histology
What is premalignant condition in endometrial cancer
Complex hyperplasia with atypia
Co-exists w/low grade endometrioid tumours
25-50% risk of progression
Staging Endometrial Cancer
FIGO - MRI Determined I - Confined to Uterine body IA - <50% invasion IB - >50% invasion II -Invading cervix III - Local/regional spread of tumour IIIA - serosa of uterus IIIB - Vagina/parametrium IIIC - Mets. pelvic/para-aortic LN IV - Invades bladder/bowel/distant mets.
Extra imaging for high grade endometrial cancer?
CT-TAP for distant mets
Surgical Mx of Endometrial cancer
Mainstay of treatment
Depends on stage, grade, co-morb
Standard: TAH+BSO (abdominal or laparoscopic)
Extra surgery for endometrial cancer and indication
Modified radical hysterectomy - cervical involvement
Pelvic + paraaortic node dissection - High grade or type 2 histology
Adjuvant treatment for endometrial cancer
Post op radio reduces local recurrence but doesnt increase survival
Local radio/brachytherapy are options
Chemo for metastatic but little evidence
Hormone treatment for endometrial cancer
High dose oral or IU progestins (LNG-IUS preferred)
For whom’st is hormone treatment for ovarian cancer indicated
Complex atypical hyperplasia and low grade IA endometrial tumours
Not fit for surgery
Want to avoid surgery for fertility
Is hormone treatment for endmetrial cancer good?
High relapse rate
Endometrial cancer and fertiity
- Primary infertility (PCOS) is a RF for premenopausal endometrial cancer
- Alternatives to hystersctomy only indicated in premal./early dx and are a/w moderate response and high relapse
- Refer for egg collection
Prognosis of endometrial cancer
5 yr survival 80%
Depends on type stage grade
Bad prognostic factors in endometrial cancer
Age Grade 3+ Type 2 histology Deep myometrial invasion LN invasion Distant mets
Endometrial hyperplasia thickness
Pre-men: <6mm reliably exludes
post menopause: >5mm abnormal
Endometrial hyperplasia Ix
TVUSS
Histology
?diagnostic hysteroscopy (gold standard)
Mx of endometrial hyperplasia w/o atypia
<5% chance malignancy in 20 yrs
Consider observation
1st line: progestogens (LNG-IUS best oral fine)
Ideally keep LNG 5yrs
Endometrial surv. every 6/12 (biopsy if high risk eg BMI)
NB. Hysterectomy and option
Reversible factors in endometrial hyperplasia
Obesity
HRT
If oral using progestogens in endometrial hyperplasia what consideration?
must be continuous not cyclical
minimum of 6mo to induce regression
Mx of endometrial hyperplasia w/atypia
- Not preserving fertility: TAH (+BSO if post-men.)
- Fertility preserving
1st line: LNG-IUS
2nd line: oral progestogens
Hysterectomy
Refer to specialist if wanting to concieve
Surveillance in endometrial hyperplasia w/atypia
Endometrial surveillance with biopsies every 3/12
If 2 consecutive negatives -> 6/12ly
