Y5 - Endometrial cancer Flashcards
def
an epithelial malignancy of the uterine corpus mucosa (usually an adenocarcinoma)
what is the cause of endometrial cancer
endometrial hyperplasia
what characterises endometrial hyperplasia
proliferation of endometrial glands which results in a greater gland-to-stroma ratio than in normal endometrium
what causes endometrial hyperplasia
chronic oestrogen stimulation unopposed by progesterone
what are possible causes of increased oestrogen
chronic anovulation (PCOS)
obesity
post-menopausal women and HRT
what are pathophysiological factors associated with endometrial cancer
oestrogen
loss of PTEN tumour suppressor gene by mutation
k-ras mutations
microsatellite instability and mismatch repair genes
p53
what is the most common form of endometrial cancer
endometrioid carcinoma
epi
most common gynaecological tumour
more common in developed countries
why is endometrial cancer more common in developed countries
obesity
signs and symptoms
post-menopausal bleeding
uterine or adnexal mass, fixed uterus
RFs
obesity (androgen excess and progesterone deficiency) >50yrs endometrial hyperplasia high oestrogen tamoxifen use as in breast cancer
investigations
pelvic (transvaginal) ultrasound
endometrial biopsy and histopathology
what may be found on pelvic (transvaginal) ultrasound in endometrial cancer
endometrial thickening >5mm
what may be found on endometrial biopsy and histopathology
confirms diagnosis histologically, identifies tumour subtype and grade
what cancer antigen is related to endometrial cancer
ca 125
management for stages I-II
staging surgery
- total hysterectomy
- bilateral salpingo-oophorectomy
- node dissection
what is removed in a total hysterectomy
uterus and cervix
what is removed in a total hysterectomy with sapingo-oophorectomy
uterus plus one or both ovaries and fallopian tubes
management for stages III-IV
staging surgery and chemotherapy -total hysterectomy -bilateral salpingo-oophorectomy -node dissection radiotherapy
what is used for chemotherapy in endometrial cancer
paclitaxel and carboplatin
what is a stage I endometrial cancer
limited to corpus uteri
A <50% myometrial invasion
B >50% myometrial invasion
what is stage II endometrial cancer
invades cervical stroma but does not extend beyond the uterus
what is stage III endometrial cancer
local and regional spread of tumour
what is stage IV endometrial cancer
tumour invades the bladder and/or bowel mucosa and/or distant metastases
