Endometrial cancer

Question 1

What is the usual presentation of endometrial cancer?

Answer 1

1. Post menopausal woman
2. 25% cases can occur before the menopause
3. Usually bleeding post menopause and can be after intercourse too (post-coital bleeding).

Question 2

Give 7 risk factors for endometrial cancer

Answer 2

1. Nulliparity
2. Early menarche and late menopause
3. Obesity
4. Tamoxifen use
5. PCOS
6. Diabetes mellitus
7. HNPCC/Lynch syndrome is a strong risk factor for endometrial cancer

Question 3

What are 3 protective factors for endometrial cancer?

Answer 3

multiparity
COCP
smoking

Question 4

What investigations are done in suspicion of endometrial cancer?

Answer 4

1. Trans-vaginal ultrasound (this is to determine the endometrial thickness, the normal is <4mm)
2. Hysteroscopy with endometrial biopsy

Question 5

What is the criteria for 2 week wait referral for cancer pathway?

Answer 5

All women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway

Question 6

Management of endometrial cancer

Answer 6

Usually surgical:
1. If localised disease, treat with total abdominal hysterectomy + bilaterial salpingo-oophorectomy
2. patients with high risk disease may have post-op radiotherapy

Question 7

When are progestogens used in management of endometrial cancer?

Answer 7

frail, elderly patients who are not medically fit for surgery