malignant disease of uterus

Question 1

classification of endometrial cancer

Answer 1

type 1 - endometrioid adenocarcinoma
arise from endometrial hyperplasia and are oestrogen dependent
type 2 high grade serous and clear cell
arise from atrophic uterus

Question 2

Why is obesity a risk factor

Answer 2

high BMI means you’re more likely to get anovulatory menstrual cycles so less likely to get pregnant
Also, androgens are aromatised to oestrogen in adipose tissue providing constant post menopausal supply of oestrogen

Question 3

RF for uterine Ca

Answer 3

early menarche late menopause
nulliparity
DM
Obesity
tamoxifen (serm that protects against oestrogen in breast but stimulates in uterus
FHx of colon and uterine ca

Question 4

bengin causes of PMB

Answer 4

Atrophic vaginitis

Unscheduled bleeding on HRT

Question 5

Dx of endometrial Ca

Answer 5

TVUSS - endometrial thickness is <4mm reassure
>5mm do hysteroscopy + biopsy
Hysteroscopy - complex hyperplasia w/ atypia is premalignant condition that can coexist with low grade tumours

Question 6

What is endometrial Ca staging called

Answer 6

FIGO

Question 7

Mx of endometrial ca

Answer 7

hysterectomy + BSO
can also give adjuvant radio (reduces recurrence but does not improve survival)
progestins if woman doesn’t want to have surgery but they’re not great

Question 8

What are some poor prognostic features of endometrial cancer?

Answer 8

age
grade 3
type 2 histology
myometrial invasion

Question 9

What are uterine sarcomas?

Answer 9

Cancer of connective tissue
Pure sarcoma - from uterine tissue (endometrial stromal sarcoma, leiomyosarcoma)
mixed epithelial sarcoma - both sarcomatous and carcinomatous. generally a post menopausal thing
heterlogous sarcoma - of tissue from other places - generally rhabdomyosarcoma

Question 10

Stages of endometrial Ca

Answer 10

endometrial hyperplasia without aplasia 
endometrial hyperplasia w/ atypia
FIGO 
1 - confined to uterine body
2 - invades cervix
3 - local or regional spread
4 - tumour invades bowel, bladder and distant mets

Question 11

Mx for premalignant conditions

Answer 11

endometrial hyperplasia w/o atypia:
address risk factors
LNG-IUS
Oral progestogens
surveillance (biopsy)

atypical hyperplasia
fertility sparing - LNG-IUS
non-fertility preserving - total hysterectomy
(if they choose medical need biopsy 3 months)