Malignant Disease of Uterus Flashcards
What is the most common gynaecologist malignancy?
ENDOMETRIAL CANCER
What are the two types of endometrial cancer?
Type 1: adenocarcinoma
Type 2: high grade serious / clear cell carcinoma
What drives growth of endometrioid adenocarcinoma?
OESTROGEN - causes proliferation of endometrial cells
What are RF for endometrial cancer?
Obesity Diabetes Nulliparity Late menopause (>52) Unopposed oestrogen Tamoxifen
What are protective factors for endometrial cancer?
Hysterectomy COCP Progestin based contraceptives IUS Smoking Pregnancy
What are Clin features of endometrial cancer
POST MENOPAUSAL BLED - red flag!
Abdo pain
Urinary dysfunction
Bowel dysfunction
How do you diagnose endometrial cancer
TVUSS - endometrial thickness >4mm, requires hysteroscopy / biopsy
Hysteroscopy w biopsy - final answer
What is staging for endometrial cancer
FIGO
1: confined to uterine body
2: invades cervix
3: spread locally/regionally
4: invades bladder, bowel, distant mets
How do you manage endometrial cancer?
Total hysterectomy with bilateral salpingo-oophorectomy
Other than endometrial cancer, what other cancers can occur in utero’
Sarcomas e.g. leiomyosarcoma
How do you investigate PMB / suspected endometrial cancer?
TVUSS
- less than 4mm – endometrial cancer very unlikely
- more than 4mm – further evaluation with hysteroscopy / biopsy
PIPELLE BIOPSY
OR
HYSTEROSCOPY
- as outpatient (local) or inpatient (GA)
When would you perform an inpatient hysteroscopy instead of as outpatient?
If they have cervical stenosis
OR
they cannot tolerate hysteroscopy awake
Why is Pipelle rarely done/?
Because it involves taking a transcervical biopsy blind
So it only works if the endometrial thickness is very generalised
What other differentials must we consider when performing an endometrial biopsy?
Simple hyperplasia (without atypia) Complex hyperplasia (with atypia)
What is complex hyperplasia with atypia?
Premalignant condition
1 in 4 progress to endometrial cancer
