Endometrial cancer

Question 1

what age group are at the highest risk of developing endometrial cancer

Answer 1

post menopausal women

Question 2

what is the aetiology of endometrial cancer

Answer 2

anything increasing levels of oestrogen such as:

• PCOS
• late menopause
• nulliparity
• obesity
• HRT
• tamoxifen
• carbohydrate intolerance

Question 3

COCP is protective in terms of endometrial cancer risk true/false

Answer 3

true - although increase in oestrogen there is no bleeding every month and therefore protective

Question 4

what is the main symptom of endometrial cancer

Answer 4

abnormal uterine bleeding

Question 5

abnormal uterine bleeding is endometrial cancer until proven otherwise true/false

Answer 5

true - must find underlying cause

Question 6

list some symptoms other than abnormal uterine bleeding that could be endometrial cancer

Answer 6

changes in discharge – blood, watery or purulent

pain is rare in early stages, mets could be present

Question 7

what areas of the body is endometrial cancer likely to spread to via direct invasion

Answer 7

myometrium
cervix
fallopian tubes

Question 8

endometrial thickness of what diameter is concerning in postmenopausal women

Answer 8

endometrial thickness of >5mm, pre-menopausal women the thickness varies throughout their cycle

Question 9

what is the first line investigation for suspected endometrial cancer

Answer 9

TUVS - this is where endometrial thickness is measured

Question 10

what is the gold standard investigation for diagnosing endometrial cancer

Answer 10

endometrial biopsy for histological analysis

Question 11

how are endometrial cancers categorised

Answer 11

type 1 and type 2 cancers

Question 12

which type is most common

Answer 12

type 1, most commonly endometrioid adenocarcinomas

Question 13

which type of endometrial cancer is oestrogen dependent

Answer 13

type 1

Question 14

what genes are associated with type 1 endometrial cancer

Answer 14

PTEN, KRAS, PIK3CA mutations

lynch syndrome

Question 15

what endometrial cancers come under type 2

Answer 15

serous carcinoma and clear cell

Question 16

which type of endometrial cancer is more aggressive/worse prognosis

Answer 16

type 2, also not associated with oestrogen

Question 17

who will type 2 typically present in

Answer 17

much older women

Question 18

type 2 endometrial cancer is associated with which mutation

Answer 18

p53

Question 19

describe FIGO staging of endometrial cancer type 1A, 1B and 1C

Answer 19

1A - confined to uterus
1B - uterus + <1/2 myometrial invasion
1C - uterus + >1/2 myometrial invasion

Question 20

describe FIGO staging of endometrial cancer stages II nS III

Answer 20

II - cervical stromal invasion but not beyond uterus

III - invades serosa or adnexae

Question 21

describe FIGO staging of endometrial cancer stages IVA and IVB

Answer 21

IVA - invasion of bladder or bowel mucosa

IVB - distant metastases including inguinal lymph nodes

Question 22

grading of tumours is split into 3 grades, describe each

Answer 22

grade 1 - 5% or less solid growth
grade 2 - between 6-50% solid growth
grade 3 - >50% solid growth

Question 23

outline the management of endometrial cancer

Answer 23

main treatment is surgical - hysterectomy + bilateral salpingo-oophrectomy
adjuvant radiotherapy to prevent recurrence
if widespread disease consider chemotherapy

Question 24

what is the treatment of endometrial cancer if the patient is unsuitable for surgery

Answer 24

radiotherapy + high dose progesterones