Endometrial cancer

Question 1

Etiology of endometrial cancer

Answer 1

1. Unopposed estrogen 
Obesity
Early menarche 
Late menopause 
Nulliparity
PCOS (anovulation - reduced progesterone)
Exogenous estrogen 
Oral contraceptives without progesterone 
Tumour producing estrogen 

2. Lynch syndrome - Autosomal dominant syndrome predisposing to cancers eg colorectal cancer and endometrial cancer
3. Age >50

Question 2

Types of endometrial cancer

Answer 2

Type 1 - Endometrioid Adenocarcinoma. Most common (90%). Good prognosis, estrogen dependent.
Type 2 - non-endometrioid carcinoma, eg serous, undifferentiated. Poor prognosis, not estrogen dependent.

Question 3

Symptoms of endometrial cancer?

Answer 3

Post menopausal bleeding
Premenopausal recurrent metrorrhagia
Pelvic pain

Question 4

Stages of endometrial cancer

Answer 4

stage 1 - confined to uterus 
stage 2 - spreads to cervix 
stage 3 - local spread
A - ovaries 
B - Vagina 
C - pelvic lymph nodes 
Stage 4 - distant spread 
A - invasion - rectum, bladder
B - Distant metastasis, Para-aortic lymph nodes

Question 5

Diagnosis of endometrial cancer?

Answer 5

Office Biopsy
D&C
Pap smear - endometrial cells in postmenopausal women
Endometrial thickness in postmenopausal women - >5mm - suspect endometrial abnormality.

Question 6

Treatment of endometrial cancer

Answer 6

Bilateral salpingo-oophorectomy
Total hysterotomy
Pelvic and intra-aortic lymphadenectomy
Radiation and chemotherapy

Question 7

Protective factors of endometrial cancer?

Answer 7

Progesterone:

Multiparity
Pregnancy
Exercise
Combined oral contraceptive / HRT containing progesterone