Ovary & Endometrium Flashcards
What does a normal cervical examination show in a post menopausal woman?
Thin, pale, atrophic cervix
What is looked at in a transvaginal USS of the endometrium
- Measure endometrial thickness
- Looks at the endometrial contour
- Biopsy if >4mm or irregular
What can you do with a hysteroscopy?
With this can inspect the whole of the uterine cavity & endocervical canal-target area of abnormality when taking biopsy
(Outpatient with LA & inpatient with GA)
How are the pathological prognostic factors of endometrial cancer assessed?
- Histological type - Based on microscopy +/- ancillary tests
- Histological grade - Microscopy
- Stage - How far tumour has spread, based on surgical resection with assessment of entire uterus and adjacent organs
- Lymphovascular space invasion (LVSI) - Microscopy of resection specimen
(MRI maybe before surgery which can give a radiological staging & Do pathological staging only when have the surgical resection specimen)
What are the two Distinct Categories of Endometrial Cancer?
TYPE 1
- Endometrioid adenocarcinoma
- Commonest
- Unopposed oestrogen
- Hyperplasia with atypia precursor
TYPE 2
- Uterine serous & clear cell carcinoma
- High grade, more aggressive, worse prognosis
- Generally older women
- Serous intraepithelial carcinoma precursor
..?.. is a risk factor for Type 1 endometrial cancer
OBESITY
Obesity=peripheral conversion of androgens in body fat into a weak oestrogen
How is endometrial cancer staged?
Surgical/Pathological
MRI
- depth of myometrial invasion
- cervical involvement
- lymph node involvement
What staging is used for endometrial cancer?
FIGO staging
What is the treatment for endometrial cancer depending on stage?
Early Stage=Surgery TAH/BSO/washings
High risk histology=Chemotherapy
Advanced Stage=Radiotherapy
Palliation=Progesterone
Endometrium is ..?.. sensitive so high levels is a risk factor for endometrial cancer
Eostrogen
What are the risk factors for endometrial cancer?
Post-menopausal women
High circulating oestrogen levels
- obesity
- unopposed E2 therapy/Tamoxifen
- PCOS
- early menarche/late menopause
Endometrial hyperplasia with atypia
HNPCC/Lynch type II familial cancer syndrome
Must combine HRT with ..?.. to protect uterus
Progesterone
Tamoxifen although it acts as an anti oestrogen in breast tissue it actually acts as what in the uterus?
An oestrogen and is associated with an increased risk of endometrial hyperplasia, endometrial adenocarcinoma and endometrial sarcoma
In women <45 with endometrial cancer what is it important to check for?
Test for Lynch also important to check this in a FH of a woman with a new onset of heavy, irregular bleeding
What are the symptoms of endometrial cancer?
- Abnormal vaginal bleeding
- PMB
What are causes of PMB (post menopausal bleeding)?
8% of women with PMB will have endometrial cancer
Hormone Replacement Therapy (HRT)
Peri-menopausal bleeding
Atrophic vaginitis
Polyps cervical/endometrial
Other cancer eg cervix, vulva, bladder,anal
Endometrial cancer is diagnosed by what?
Histology of the endometrium
What is the main treatment for endometrial cancer?
Total abdominal hysterectomy with removal of tubes & ovaries & peritoneal washings
Who does ovarian cancer present in?
Rare < 30 years
High risk families 5-10% of cases
- HNPCC/Lynch type II familial cancer syndrome
- BRCA1
- BRCA2
‘Incessant ovulation’
OCP protective
Where do most cases of ovarian cancer probably originate from?
Most cases probably actually originate from the fallopian tube
Some derive from pre-existing benign ovarian cysts (often low grade cancers)
What genes are linked to high grade ovarian serous carcinoma?
p53
BRCA 1
BRCA 2
What are the symptoms of ovarian cancer?
Vague!
Indigestion/early satiety/poor appetite
Altered bowel habit/pain
Bloating/discomfort/weight gain
Pelvic mass
- asymptomatic
- pressure symptoms
How is ovarian cancer diagnosed?
Surgical/Pathological
US Scan abdomen and pelvis
CT Scan
CA 125 (enzyme which can be measured)
Surgery
What conditions can CA125 be associated with?
Malignancy
- ovary
- colon/pancreas
- breast
Benign conditions
- menstruation/endometriosis/PID
- liver disease/recent surgery/effusions
What is CA125 used for in the context of ovarian cancer?
Used in detecting and monitoring epithelial ovarian tumours
What is included in risk of malignancy index (RMI) for ovarian cancer?
RMI=U x M x CA 125
Ultra sound features
- multi-locular
- solid areas
- bilateral
- ascites
- intra-abdominal
Menopausal status
CA 125 level
How is ovarian cancer treated?
Surgery
+/-
Chemo (adjuvant or neoadjuvant)
- within 8 weeks of surgery
- First line Platinum and taxane (Taxol)
- Complete/partial response
- Cure unlikely
- Average response 2 years
What is a laparotomy used for in ovarian cancer?
Obtain tissue diagnosis
Stage disease
Disease clearance
Debulk disease
What is done for a recurrence of ovarian cancer?
Chemotherapy
Palliation
- symptomatic recurrence
Platinum if > 6months
?Surgery
Tamoxifen
Who is screened for ovarian cancer?
Population screening NOT proven
High risk women
- cancer gene mutation carriers
- 2 or more relatives
Pelvic examination
US scanning of ovaries
CA 125
With what stage disease does ovarian cancer usually present with?
Stage 3 or 4 disease
- Poor prognosis
What can surgery be used for in ovarian cancer?
To stage & to reduce disease bulk
