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reproductive health > Endometria cancer and hyperplasia > Flashcards

Endometria cancer and hyperplasia Flashcards

1
Q

What is the most common kind of endometrial cancer

A

Adenocarcinoma

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2
Q

What presentation is endometrial cancer until proven otherwise

A

Postmenopausal bleeding

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3
Q

Key risk factors for endometrial cancer

A

Obesity and diabetes

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4
Q

What affect does oestrogen have on adenocarcinoma

A

Oestrogen-dependent - stimulates growth of endometrial cancer cells

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5
Q

What is endometrial hyperplasia

A

Precancerous thicking of endometrium (<5% -> cancer, most resolve)

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6
Q

Types of endometrial hyperplasia to be aware of

A

Hyperplasia without atypia
Atypical hyperplasia

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7
Q

What are most of the risk factors for endometrial hyperplasia based around

A

Exposure to oestrogen without progesterone (unopposed oestrogen)

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8
Q

Risk factors for endometrial cancer

A

Exposure to unopposed oestrogen eg
Increased age
Earlier onset menstruation
Late menopause
Oestrogen only HRT
no or fewer pregnancues
Obesity
PCOS
tamoxifen

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9
Q

How does PCOS increase risk of endometrial cancer

A

Lack of ovualtion, lack of corpus luteum that produces progesterone + therefore endometrial protection during luteal phase (second half menstrual cycle)
Insulin resistance and increased production

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10
Q

How should women with PCOS have endometrial protection

A

COCP
Intrauterine system eg mirena coil
Cyclical progesterons to induce withdrawal bleed

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11
Q

Why does obesity increase risk of endometrial cancer

A

Adipose tissue produces oestrogen - primary source in postmenopausal women

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12
Q

How is adipose tissue oestrogen producing

A

Contains aromatase, breaks down androgens eg testosterone into oestrogen

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13
Q

WHat effect does tamoxifen have on breast tissue vs endometrium

A

Anti-oestrogenic on breast tissue
Oestrogenic risk on endometrium - increase cancer risk

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14
Q

What risk factors for endometrial cancer unrelated to unopposed oestrogen

A

T2DM
Hereditary nonpolyposis colorectal cancer or lynch syndrome

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15
Q

How does T2DM increase endometrial cancer risk

A

Increased insulin which stimulates endometrial cells and increase risk of endometria hyperplasia and cancer

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16
Q

Protective factors against endometrial cancer

A

COCP
Mirena coil
Increased pregnancies
Smoking - anti-oestrogenic effect

17
Q

Endometrial cnacer presentation

A

Postcoital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count

18
Q

When does NICE recommend a transvaginal US in women >55

A

Unexplained vaginal discharge
Visible haematuria

19
Q

What investigations for diagnosing endometrial cancer

A

Transvaginal US for endometrial thickness
Pipelle biopsy
Hysteroscopy w endometrial biopsy

20
Q

What is normal in postmenopausal woman on transvaginal US

A

<4mm

21
Q

When is pipelle biopsy used over hysteroscopy

A

Wuicker and less invasive for lower risk women

22
Q

Staging used for endometrial cancer

A

The International Federation of Gynaecology and Obstetrics (FIGO) staging system is used to stage endometrial cancer:
* Stage 1: Confined to the uterus
* Stage 2: Invades the cervix
* Stage 3: Invades the ovaries, fallopian tubes, vagina or lymph nodes
* Stage 4: Invades bladder, rectum or beyond the pelvis

23
Q

What is the usual treatment for stage I and 2 endometrial cancer

A

Total abdominal hysterectomy with bilateral salpingo-oopherectomy
eg TAH and BHO - removal of uterus, cervix and adnexa

24
Q

What are the treatment options for endometrial cancer

A

Radical hysterectomy also removing pelvic lymph nodes, surrounding tissues and top of vagina
Radiotehrapy
Chemotherapy
Progesterone - slow progression

25
Q

What are progestogens and what are they used for

A

Intrauterine system - mirena coil
Continous oral progesterogens eg medroxyprogesterone or levonorgestrel

reproductive health (69 decks)

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