Pathology of the Uterus Flashcards
How many women with PMB will have endometrial cancer?
8%
PMB stands for….
Post menopausal bleeding
Causes of post menopausal bleeding
Endometrial cancer Hormone replacement therapy (HRT) Peri-menopausal bleeding Atrophic vaginitis Polyps - cervical/endometrial Other cancer - cervix, vulva, bladder, anal
Definition of atrophic vaginitis
Thinning, drying and inflammation of the vaginal walls due to your body having less oestrogen
Investigations for Post menopausal bleeding
- Transvaginal USS
- Endometrial biopsy (if endometrial thickness >4mm or irregular contour)
- Hysteroscopy
What does a transvaginal USS look at when investigating PMB?
Endometrial thickness
Endometrial contour
Normal findings on transvaginal USS in post menopausal women
Endometrium should be thin <4mm
Shouldn’t be tissue there
What stage do women usually present with in endometrial cancer?
Stage 1
What stage of menstruation/menopause does endometrial cancer present in?
Post menopausal women
Risk factors for endometrial cancer
HIGH CIRCULATING OESTROGEN LEVELS - obesity - unopposed E2 (oestrogen) therapy/tamoxifen - PCOS - Early menarche/late menopause Hypertension DM Nulliparity
What familial cancer syndrome is related to endometrial cancer?
HNPCC/Lynch type II familial cancer syndrome
Pathological name of endometrial cancer
Atypical endometrial hyperplasia
Symptoms of endometrial cancer
Abnormal vaginal bleeding
- premenopausal women may have IMB
- Post menopausal bleeding
What is the most common symptom of endometrial cancer
Post menopausal bleeding
MRI staging of endometrial cancer looks at….
Depth of myometrial invasion
Cervical involvement
Lymph node involvement
Staging name of endometrial cancer
FIGO staging
Stages of endometrial cancer
1A - inner half of myometrium IB - outer half of myometrium 2 - invades cervix 3A - serosa/adnexa 3B - vagina/parametrium 3C - pelvic or paraaortic nodes 4 - bladder/bowel/intra-abdominal/inguinal nodes
Two distinct categories of endometrial cancer
Type 1
Type 2
Type 1 endometrial cancer features
Endometrial adenocarcinoma
By far the commonest
Unopposed oestrogen
Hyperplasia with atypia precursor
Unopposed oestrogen meaning
The use of oestrogen alone i.e. without progesterone
Type 2 endometrial cancer features
Two types (uterine serous carcinoma + Clear cell carcinoma)
high grade, more aggressive, worse prognosis
Generally older ladies
Serious intraepithelial carcinoma precursor
Not so much associated with obesity of unopposed oestrogen so different pathways etc
Two types of type 2 endometrial cancer
- Uterine serous carcinoma
2. Clear cell carcinoma
Investigations of endometrial cancer
Transvaginal USS scan (endometrial thickness and contour)
Histology of the endometrium
Treatment of endometrial cancer
Early stage - Surgery TAH/BSO/washings High risk cytology - chemotherapy Advanced stage - radiotherapy Palliation - progesterone
When is laparoscopy done in surgery instead of laparotomy?
When there is complications e.g. diabetic, obesity
TAH stands for…
Total abdominal hysterectomy
BSO stands for….
Bilateral Salpingo-oophrectomy
BSO involves ….
the removal of tubes and ovaries
Washings involves….
Peritoneal washings
Cure rates for the stages of endometrial cancer
IB = 85% IIA = 75% IIB = 60% IIIB = 30% IV = 21%
Why is the overall cure rate for endometrial cancer good?
Tend to present earlier as notice the bleeding
The incidence of endometrial cancer is increasing due to …..
increasing obesity
What drug is a risk factor for endometrial hyperplasia?
Tamoxifen
Why does endometrial hyperplasia develop?
Due to the presence of unopposed oestrogen
Management of endometrial hyperplasia
Without atypia - high dose progesterones (IUS may be used)
Atypia - hysterectomy usually advised
