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Gynae > Malignant Disease of the Uterus > Flashcards

Malignant Disease of the Uterus Flashcards

1
Q

Suspect endometrial cancer Ix

A

TVUSS
?Hysteroscopy
?Staging

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2
Q

RF for Endometrial cancer

A 
No. menstrual cycles
PCOS
Obesity
FHx
Br/Ovarian Ca.
Endometrial hyperplasia
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3
Q

Protective factors against endometrial cancer

A 
Interrupted cycles (Pregnancy, anovulation from contraception)
Healthy lifestyle
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4
Q

TVUSS in endometrial cancer

A

Measures endometrial thickness
<4mm = unlikely cancer
>4mm requires hysteroscopic biopsy

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5
Q

Hysteroscopy for ?endometrial cancer

A

LA
OutPt if possible
GA if cervix stenosed or hysteroscopy poorly tolerated
Biopsy for histology

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6
Q

What is premalignant condition in endometrial cancer

A

Complex hyperplasia with atypia
Co-exists w/low grade endometrioid tumours
25-50% risk of progression

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7
Q

Staging Endometrial Cancer

A 
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.
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8
Q

Extra imaging for high grade endometrial cancer?

A

CT-TAP for distant mets

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9
Q

Surgical Mx of Endometrial cancer

A

Mainstay of treatment
Depends on stage, grade, co-morb
Standard: TAH+BSO (abdominal or laparoscopic)

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10
Q

Extra surgery for endometrial cancer and indication

A

Modified radical hysterectomy - cervical involvement

Pelvic + paraaortic node dissection - High grade or type 2 histology

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11
Q

Adjuvant treatment for endometrial cancer

A

Post op radio reduces local recurrence but doesnt increase survival
Local radio/brachytherapy are options
Chemo for metastatic but little evidence

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12
Q

Hormone treatment for endometrial cancer

A

High dose oral or IU progestins (LNG-IUS preferred)

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13
Q

For whom’st is hormone treatment for ovarian cancer indicated

A

Complex atypical hyperplasia and low grade IA endometrial tumours
Not fit for surgery
Want to avoid surgery for fertility

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14
Q

Is hormone treatment for endmetrial cancer good?

A

High relapse rate

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15
Q

Endometrial cancer and fertiity

A
  • 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
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16
Q

Prognosis of endometrial cancer

A

5 yr survival 80%

Depends on type stage grade

17
Q

Bad prognostic factors in endometrial cancer

A 
Age
Grade 3+ 
Type 2 histology
Deep myometrial invasion
LN invasion
Distant mets
18
Q

Endometrial hyperplasia thickness

A

Pre-men: <6mm reliably exludes

post menopause: >5mm abnormal

19
Q

Endometrial hyperplasia Ix

A

TVUSS
Histology
?diagnostic hysteroscopy (gold standard)

20
Q

Mx of endometrial hyperplasia w/o atypia

A

<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

21
Q

Reversible factors in endometrial hyperplasia

A

Obesity

HRT

22
Q

If oral using progestogens in endometrial hyperplasia what consideration?

A

must be continuous not cyclical

minimum of 6mo to induce regression

23
Q

Mx of endometrial hyperplasia w/atypia

A
  • 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
24
Q

Surveillance in endometrial hyperplasia w/atypia

A

Endometrial surveillance with biopsies every 3/12

If 2 consecutive negatives -> 6/12ly

25
Q

PACES counselling of Endom. Hyperplasia/EC

A 
Ix; scans, hysteroscopy, biopsy
Dx; thickening of lining, ?cancer
No atypia: LNG-IUS FU 3mo
Atypia TAH+BSO
Cancer TAH+BSO
Refer to specialistif wanting to retain fertility

Gynae (20 decks)

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