Pathology of uterus

Question 1

Features of endometrial cancer

Answer 1

• Post-menopausal women
• High circulating oestrogen levels
  
  • Obesity (peripheral oestrogen conversion)
  • Unopposed E2 therapy/ tamoxifen
  • PCOS (steady state of oestrogen levels)
  • Early menarche/ late menopause
• Endometrial hyperplasia with atypia
• HNPCC/ Lynch type II familial cancer syndrome

Question 2

Symptoms of endometrial cancer

Answer 2

• Abnormal vaginal bleeding
• Post-menopausal bleeding

Question 3

Treatment of endometrial cancer

Answer 3

• Early stage → Total abdominal hysterectomy (TAH), bilateral salphingo-oophrectomy
• High risk histology → + chemotherapy
• Advanced stage → radiotherapy
• Palliation → progesterone (malignancy is progesterone sensitive)

Question 4

Causes of post-menopausal bleeding

Answer 4

• Hormone-replacement therapy (HRT)
• Peri-menopausal bleeding
• Atropic vaginitis
• Polyps cervical/ endometrial
• Other cancers e.g cervical/ vulval/ bladder anal
• Only 8% → endometrial cancer

Question 5

Summary of endometrial cancer

Answer 5

• Red flag → post-menopausal bleeding
• Transvaginal scan to look at endometrium thickness and contour
• Diagnosis → histology of endometrium
• Treatment → total abdominal hysterectomy + removal of tubes and ovaries + peritoneal washings