endometrial CA

Question 1

type 1

Answer 1

90% of endometrial adenocarcinoma
estrogen dependant
occur in younger woman
good prognosis

Question 2

type 2

Answer 2

occur in elderly
non estrogen dependant
poor prognosis

Question 3

risk factor

Answer 3

obesity
diabetes
nulliparous
late menopause >52 yo
unopposed oestrogen therapy
tamoxifen therapy
HRT
fam hx of colorectal or ovarian cancer

Question 4

HNPCC( hereditary non-polyposis colorectal cancer syndrome)

Answer 4

• autosomal dominant inheritance resulting in mutation of mismatch repair gene MLH1,MSH2 and MSH6
• associated with crc,ovarian,endometrial and urothelial tumours

Question 5

clinical features

Answer 5

PMB
pms women-IMB,blood stained vaginal discharge,HMB,lower abd pain and dyspareunia
advanced ca-metastases

Question 6

dx

Answer 6

speculum xm-blood arising from cervix
bimanual-enlarged uterus
TVS-endometrial thickness
hysteroscopy-direct visualization of the whole endometrium and allows a directed biopsy to be performed
endometrial sampling
MRI-extent of ds

Question 7

type of CA

most common:adenocarcinoma

Answer 7

type 1:endometrioid adenocarcinoma

type 2:serous papillary carcinoma

Question 8

FIGO staging of CA uterus(2009)

Answer 8

1-confined to uterine body
1a- 50% invasion
2-tumour imvading cervical stroma
3-local and or regional spread of tumour
3a-invade serosa of uterus
3b-invades vagina/parametrium
3c-metastases to pelvic and/or para aortic nodes
4-tumour invades bladder+-bowel+-distant metastases

Question 9

surgical mx

Answer 9

stage 1-2/MRI shows1b-total hysterectomy,bilateral sapingectomy
MRI suggest cervical involvement-radical hysterectomy with pelvic noce dissection
stage 3/papillary serous-pelvic and paraaortic node dissection

Question 10

adjuvant tx

Answer 10

post-op radiotherapy will reduce local recurrence rate
HDR(high dose radiotherapy) to the vaginal vault
external beam radiotherapy+HDR-stage 3
chemotherapy-given for metastatic ds

Question 11

prognosis

Answer 11

1-88%
2-75%
3-55%
4-16%