Uterine Cancer Flashcards
Non-cancerous lesions of the uterus
Leiomyoma
Endometrial polyp
Hyperplasia with atypia
Epidemiology of Uterine Ca
12/100,000pa in the UK
4000 cases/yr - 7% of Ca in women in UK - now commoner than Cervical Ca
Pathogenesis of Uterine Ca
Two Types: unopposed prolonged oestrogen stimulation leading to atypical endometrial hyperplasia (HRT, COC, late menopause)
Atrophic, post-menopausal endometrium without diffuse hyperplasia –>less differentiated and worse prognosis
Risk factors for uterine Ca
Much more common in the west due to obesity, late menopause and nulliparity -oestrogen exposure
Smoking is thought to decrease the risk of endometrial Ca
Presentation of Uterine Ca
Abnormal post-menopausal bleeding
Transvaginal USS - identify thickened uterus
Diagnosis is by curettage or pipelle biopsy
Pathology of uterine Ca
Can be Localised polypoid tumours OR diffuse through the endometrium
Gland forming adenocarcinoma are most common, rarely can get sarcomas
Spread of uterine Ca
Direct myometrial invasion of cervix and peri-uterine structures (ovary, vagina, bladder) –> lymph nodes then distant mets
Can also spread across peritoneum
Staging of Uterine (endometrial) Ca
T0 - in situ Ca
T1 - within the uterus, a - endometrium, b - 1/2 myometrium, c - >1/2 of myometrium
T2 - spread to cervix, a - glandular tissue, b - cervical stroma
T3 - local spread, a - adnexa/serosa spread, b - vaginal involvement
T4 - into bladder or bowel
M1 - distant mets
Treatment of Endometrial Ca
TAH+BSO +- lymphadenectomy (parametrial spread is rare so radiacal Hy not used)
Radio or chemo if high risk of relapse (highest risk at vaginal vault)
Five yr survival of Uterine Ca
Stage 1 - 90%
Stage 2 - 30-50%
Stage 3 - <20%
Most pts present at stage 1
