Uterine Cancer Flashcards
Most common uterine cancer?
Adenocarcinoma
What is considered to be a risk factor for endometrial malignancy?
High levels of oestrogen
Where do most uterine malignancies arise?
Endometrium
Factors which may increase oestrogen?
- PCOS
- Late menopause
- Nulliparity
- Obesity
- Unopposed oestrogen HRT
- Tamoxifen
- Oestrogen secreting tumours
What syndrome causes microsatellite instability due to defect in mismatch repair genes and increases risk of colorectal and endometrial cancers?
Lynch syndrome/HNPCC
3 forms of endometrial hyperplasia?
Simple
Complex
Atypical
When does simple endometrial hyperplasia occur?
Peri-menopausal period
What is simple endometrial hyperplasia due to?
-Oestrogen stimulation particularly associated with anovulatory cycles but rarely with oestrogen therapy or oestrogen secreting tumour
Clinical presentation of simple endometrial hyperplasia?
Irregular, frequent and heavy bleeding
What is atypical endometrial hyperplasia?
Hyperplasia is focal and cytological atypia with mitotic figures
-Considered pre-cancerous and risk of adenocarcinoma developing
What are80% of endometrial carcinomas?
Type I cancers:
- Called endometroid tumours
What are type I cancers relate to?
Unopposed oestrogen and with atypical hyperplasia
What is unopposed oestrogen?
Oestrogen without progesterone
What type of cancer includes serous and clear cell cancers?
Type II tumours
Endometrial carcinomas are extremely rare. True or false?
False
-Common cancer
What is leiomyosarcoma?
Rare malignant uterine tumour of myometrium
How does leiomyosarcoma?
- Can arise de novo
- Or from existing leiomyoma (fibroid)
Presnetation of endometrial cancers?
- Abnormal uterine bleeding (Principle)
- Vaginal discharge (less common)
- Pain is rarely in early disease
Post menopausal bleeding is….?
Malignancy until proven otherwise
Investigations for endometrial cancers?
- Transvaginal ultrasound = 1st line
- Endometrial biopsy
- Dilation and curettage
- Hysteroscopy can allow visualization of uterine cavity enabling biopsy/curettage to be done
What investigation finding would indicate malignancy is unlikely?
Smooth endometrium <4cm
Mainstay management of endometrial cancers?
Hysterecyomy with bilateral salpingo-oophrectomy
What treatment can be used adjuvant to prevent reoccurrence?
Radiotherapy
What treatment for uterine cancers can be used for candidates unsuitable for surgery?
Radiotherapy
High dose progesterones
When would chemo be considered as treatment?
Widespread disease
Usual prognosis for uterine cancers?
Good with no recurrence
