Uterus 2

Question 1

What is the management for endometrial cancer?

Answer 1

• 75% of patients present with Stage 1- leading to a hysterectomy and bilateral salpinogo-oophorectomy (BSO) either abdominally or laparoscopically
• External beam radiotherapy- used following hysterectomy in patients considered ‘high risk’ and above for
lymph node involvement, used for pelvic recurrence, most beneficial if it has not been given previously
• Vaginal vault radiotherapy, used where the above risk factors are present, usuage reduces local recurrence, but does not prolong survival
• Chemotherapy- may have a limited role in high-risk early and advanced-stage disease, though the response may be modest

Question 2

What are the risk factors for lymph node involvement from pathological examination of the uterus?

Answer 2

o Deep myometrial spread
o Poor tumour histology or grade
o Cervical stroma involvement (eg. Stage 2b)

Question 3

What is the prognosis for endometrial cancer?

Answer 3

•	Recurrence is most common at the vaginal vault- normally in the first 3 years
•	Poor prognostic features are
o	Older age
o	Advanced clinical stage
o	Deep myometrial invasion in Stage 1&2
o	High tumour grade
o	Adenosquamous histology

Question 4

What are uterine sarcomas?

Answer 4

accounting for only 150 cases per year in the UK, there are 3 categories
o Leiomyosarcomas- malignant fibroids
o Endometrial stromal tumours- tumours of the stroma beneath the endometrium, range from benign nodule to highly malignant stromal sarcoma, most common in the peri-menopausal women
o Mixed Mullerian tumours- derived from embryological tissue, more common in old age

Question 5

How do uterine sarcomas present?

Answer 5

• Present with irregular or post-menopausal bleeding leiomyosarcomas also show rapid painful enlargement of a fibroid

Question 6

What is the management for uterine sarcomas?

Answer 6

• Treatment is hysterectomy, radiotherapy or chemotherapy may be used subsequently, but overall survival is only 30% at 5 years