Pathologies of the Uterus

Question 1

What are the risk factors for endometrial cancer?

Answer 1

• Post-menopausal women
• High circulating oestrogen levels (obesity, unopposed E2 therapy/Tamoxifen, Polycystic ovarian syndrome (PCOS), early menarche/late menopause)
• Atypical endometrial hyperplasia
• HNPCC/Lynch type II familial cancer syndrome
• Peak age in late 70s

Question 2

What is the most common symptom of endometrial cancer?

Answer 2

Abnormal bleeding or post-menopausal bleeding

Question 3

What are the causes of post-menopausal bleeding?

Answer 3

Endometrial cancer (8%)
Hormone Replacement Therapy (HRT)
Peri-menopausal bleeding
Atrophic vaginitis
Polyps cervical/endometrial
Other cancer eg cervix, vulva, bladder, anal

Question 4

How is endometrial cancer investigated?

Answer 4

Transvaginal ultrasound to assess endometrial thickness and contour
Diagnosis made on histology of endometrium

Question 5

How is endometrial cancer staged?

Answer 5

• 1A- Inner half of myometrium affected
• 1B- Outer half of myometrium affected
• 2- Invades cervix
• 3A- Serosa or adnexa affected
• 3B- Vagina or perimetrium affected
• 3C- Pelvic or para-aortic lymph nodes affected
• 4- Bladder, bowel, intra-abdominal or inguinal node involvement

Question 6

What are the two types of endometrial cancer?

Answer 6

Type 1 and type 2

Question 7

What are the characteristics of type 1 endometrial cancer?

Answer 7

• Endometrioid adenocarcinoma
• By far the commonest
• Unopposed oestrogen
• Hyperplasia with atypia precursor

Question 8

What are the characteristics of type 2 endometrial cancer?

Answer 8

• Uterine serous & clear cell carcinoma
• High grade, more aggressive, worse prognosis
• Generally older women
• Serous intraepithelial carcinoma precursor

Question 9

How is early stage endometrial cancer treated?

Answer 9

Surgery:
Total laparoscopic hysterectomy
Bilateral salpingoopherectomy
Washings

Question 10

How is endometrial cancer with high risk cytology treated?

Answer 10

Chemotherapy

Question 11

How is advanced stage endometrial cancer treated?

Answer 11

Radiotherapy

Question 12

What palliative treatment can be given for endometrial cancer?

Answer 12

Progesterone

Question 13

What are the cure rates of endometrial cancer?

Answer 13

Stage IB- 85%
Stage IIA- 75%
Stage IIB- 60%
Stage IIIB- 30%
Stage IV- 21%