Pathology of the uterus Flashcards
What is done in a trans-vaginal ultrasound scan?
Measure endometrial thickness
Look at endometrial contour
Biopsy if >4mm or irregular
What is used to give a prognosis in endometrial cancer?
Histological type
Histological grade
Stage
Lymph-vascular space invasion
What is done to stage endometrial cancer?
MRI to assess depth of myometrial invasion, cervical involvement, and lymph node involvement
How is Endometrial cancer staged?
Stage 1A - inner half of myometrium Stage 1B - outer half of myometrium Stage 2 - Invades cervix Stage 3A - Serosa/adnexa Stage 3B - Vagina/parametrium Stage 3C - Pelvic or para-aortic nodes Stage 4 - Bladder/bowel/intra-abdominal/inguinal nodes
What is type 1 endometrial cancer?
Endometrioid adenocarcinoma
Commonest
Unopposed oestrogen
Hyperplasia with atypia precursor
What is type 2 endometrial cancer?
Uterine serous and clear cell carcinoma
High grade, more aggressive, worse prognosis
Generally older women
Serous intraepithelial carcinoma precursor
How is early stage endometrial cancer treated?
Surgery - total abdominal hysterectomy/bilateral salpingo-oophectomy
How is endometrial cancer with high risk histology treated?
Chemotherapy
How is advanced stage endometrial cancer treated?
Radiotherapy
How is palliation given for uncurable endometrial cancer?
Progesterone
What are risk factors for endometrial cancer?
Post-menopausal women High circulating oestrogen levels Obesity PCOS Early menarche/late menopause Atypical endometrial hyperplasia HNPCC/Lynch type II familial cancer syndrome
What are symptoms of endometrial cancer?
Abnormal vaginal bleeding
Post menopausal bleeding
What are causes of post-menopausal bleeding?
Endometrial cancer Hormonal replacement therapy Peri-menopausal bleeding Atrophic vaginitis Polyps cervical/endometrial Other cancer - cervix, vulva, bladder, anal
