3 - Gynae - The Uterus and its abnormalities - Endometrial Ca

Question 1

relative prevalence? peak age? often incorrectly considered ? due to ? but stage for stage prognosis similar to ?

Answer 1

most common genital tract cancer
prev highest at 60
often incorrectly considered benign as present early but stage for stage prognosis is similar to ovarian cancer

Question 2

pathology - >90% are what? what is most common of the rest? prog?

Answer 2

> 90% adenoca of columnar endo gland cells

adenosquamous Ca - squam and glandular tissue - poorer prog

Question 3

aetiology - what is the 1’ risk? therefore, malignancy most common when? or when?

Answer 3

high oestr:prog ratio

when oestr prod is high or when oestr therapy used unopposed by progestogens

Question 4

RF’s - what incr rate x6? why is obesity a RF? what drug incr risk and why? what two things are protective?
4 other RF’s (2 are simple, 1 is a tumour)

Answer 4

exogenous oestrogens wo prog incr rate x6
obesity - peripheral conversion of androgens to oestrogen by adipose
tamoxifen - oestrogen agonist in post-menopausal uterus
COCP and preg protective
HTN, DM, PCOS as/w amenorrhea, nulliparity, late menopause
ovarian granulosa (oestr secr) cell tumours

Question 5

clinical features - what gives 10% risk of endo ca? what about premenopausal women?

Answer 5

Post menopausal bleeding = 10% risk

they get a ‘change’ - irreg, IMB or heavier

Question 6

screening - what is done? why? what if taking tamoxifen?

Answer 6

none - present early - prob worthwhile if taking tamoxifen

Question 7

Ix - if PMB ? what also if endo >4m thick or multi episodes? if premenopausal? do biopsy if? what to consider doing? why CXR? 4 others you may want? (to assess pt fitness)

Answer 7

USS
if >4mm/multi = biopsy by pipelle or during hysteroscopy

USS then biopsy if abnormal or change in periods and >40y
MRI
to r/o rare pulm spread
FBC, U+E, , glucose, ECG

Question 8

Staging - only poss after?

4 stages - describe

Answer 8

hysterectomy
1 - uterus only, A is <0.5 myometrial invasion, B is >0.5
2 - cervix also
3 - pelvic/para-aortic LNs
4 - bowel and bladder or distant spread

Question 9

trt - usually what? or what? and? if LN +/likely to be +ve?

Answer 9

usually total abdo/lap hysterectomy and BSO

radiotherapy if LN +/likely to be

Question 10

prognosis - dep on what 4 things? overall 5-y survival?

Answer 10

pt fitness, clinical stage, grade, histology

75%