Management of women with PMB 2012 TOG

Question 1

If PBM what are chance of having endometrial cancer

Answer 1

10%

Question 2

Most common cause of PMB

Answer 2

Atrophic endometritis and vaginitis 60-80%

Question 3

How common PMB cause by
- Exogenous oestrogens
- Hyperplasia
- Polyps

Answer 3

• Exogenous oestrogens: 15-25%
• Hyperplasia 5-15%
• Polyps 2-12%

Question 4

What % of women with endometrial cancer present with bleeding?

Answer 4

90%

Question 5

Pre probability of endometrial cancer if PMB >80yrs

Answer 5

25%

Question 6

Pre probability of endometrial cancer if PMB <50yrs

Answer 6

1%

Question 7

Pre probability of endometrial cancer if PMB & obese

Answer 7

18%

Question 8

Pre probability of endometrial cancer if PMB & diabetes

Answer 8

21%

Question 9

Pre probability of endometrial cancer if PMB obesity & diabetes?

Answer 9

29%

Question 10

RF for endometrial cancer

Answer 10

Obesity
Unopposed oestrogens
PCOS
Nulliparity
Diabetes
Family/Personal history of some cancers
Tamoxifen
Early menarche and late menopause

Question 11

Flow diagram for investigation for PMB

Answer 11

Question 12

Risk of atypical hyperplasia in women with polyps
1) Symptomatic
2) Asymptomatic

Answer 12

1) 2.2%
2) 1.2%

Question 13

How much does tamoxifen increase the risk of endometrial cancer?

Answer 13

3-6 fold
Treatment > years increases this by a further 4 fold