Endometrial Carcinomas Flashcards
What are the different classes of endometrial carcinomas?
- Type 1 – Endometrioid adenocardinoma
- Commonest
- Hyperplasia with atypia precurser
- Type 2 – uterine serous and clear cell carcinoma
- High grade, worse prognosis
- Older woman
- Serous intraepithelial carcinoma precursor
Which class of endometrial carcinomas has worse prognosis?
- Type 1 – Endometrioid adenocardinoma
- Commonest
- Hyperplasia with atypia precurser
-
Type 2 – uterine serous and clear cell carcinoma
- High grade, worse prognosis
- Older woman
- Serous intraepithelial carcinoma precursor
Which class of endometrial carcinoma is commonest?
-
Type 1 – Endometrioid adenocardinoma
- Commonest
- Hyperplasia with atypia precurser
- Type 2 – uterine serous and clear cell carcinoma
- High grade, worse prognosis
- Older woman
- Serous intraepithelial carcinoma precursor
What is the precurser for type 1 and type 2 endometrial carcinoma?
- Type 1 – Endometrioid adenocardinoma
- Commonest
- Hyperplasia with atypia precurser
- Type 2 – uterine serous and clear cell carcinoma
- High grade, worse prognosis
- Older woman
- Serous intraepithelial carcinoma precursor
Which class of endometrial carcinoma affects older woman?
- Type 1 – Endometrioid adenocardinoma
- Commonest
- Hyperplasia with atypia precurser
-
Type 2 – uterine serous and clear cell carcinoma
- High grade, worse prognosis
- Older woman
- Serous intraepithelial carcinoma precursor
How is the classification of endometrial carcinomas likely to change in the future?
Classification is changing, in future likely to be based on molecular findings:
- Molecular testing on tumour tissue to look for certain mutations and genetic aberrations such as P53 mutations or microsatellite instability
What are risk factors for endometrial carcinoma?
- High circulating oestrogen levels
- Obesity
- Unopposed E2 therapy
- Polycystic ovarian syndrome
- Early menarche/early menopause
- Endometrial hyperplasia with atypia
- HNPCC/Lynch type II familial cancer syndrome
- Post-menopausal
- Hypertension
- Diabetes
Where does endometrial cancer rank in womans cancers prevalence?
- Uterine cancer in 4th place
- Ovarian cancer in 6th place
- (most common is breast, then lungs, then bowel)
Describe the presentation of endometrial carcinoma?
- Abnormal vaginal bleeding
- Post-menopausal bleeding (PMB) for most woman
- Intermenstrual or heavy bleeding for people with family history of HNPCC
- Pain with urination or sexual intercourse
- Pelvic pain
What investigations are done for endometrial carcinoma?
- Trans-vaginal USS
- Measure endometrial thickness and look at contour
- Biopsy if >4mm or irregular
- Measure endometrial thickness and look at contour
- Endometrial biopsy
- Such as pipelle endometrial biopsy
- Hysteroscopy
- Done if not possible to do pipelle endometrial biopsy or suspicion of underlying pathology
- MRI
- Used for staging – depth of myometrial invasion, cervical involvement and lymph node involvement
How is staging of endometrial cancer done?
Staging is done by surgical/pathological means and MRI
What are the different stages of endometrial carcinoma?
Describe the management for endometrial carcinoma?
- Early stage
- Total laparoscopic hysterectomy
- Bilateral salpingoophorectomy
- With peritoneal washings
- High risk
- Chemotherapy
- Advanced stage
- Radiotherapy
- Palliation
- Progesterone
What does the prognosis of endometrial carcinoma depend on?
- Depends on
- Histological type
- Histological grade
- Stage
- Lymphovascular space invasion (LVSI)
- Cure rates for each stage
- IB – 85%
- IIA – 75%
- IIB – 60%
- IIIB – 30%
- IV – 21%
