Endometrial cancer Flashcards
(18 cards)
What is the most common endometrial cancer?
Adenocarcinoma which is oestrogen dependent so oestrogen stimulates the growth of endometrial cancer cells.
What is endometrial hyperplasia?
A precancerous condition involving thickening of the endometrium.
What are the 2 types of endometrial hyperplasia?
Hyperplasia without atypia and atypical hyperplasia.
How can you treat endometrial hyperplasia?
Using progestogens
Intrauterine system eg. Mirena, Continuous oral progestogens (levonorgestrel).
What are the risk factors?
Increased age, earlier onset of menstruation, late menopause, oestrogen only HRT, obesity, diabetes, no pregnancies, PCOS.
Why are women with PCOS at an increased risk of endometrial cancer?
Women with PCOS are less likely to ovulate, leading to no progesterone and more exposure to unopposed oestrogen.
What should women with PCOS have for endometrial cancer protection?
- COCP
- an intrauterine system (progesterone), - cyclical progestogens to induce a withdrawal bleed.
Why is obesity a risk factor for endometrial cancer?
Adipose tissue is a source of oestrogen as it contains aromatase which converts androgens into oestrogen.
What medication can increase the risk of endometrial cancer?
Tamoxifen - it has an anti-oestrogenic effect on breast tissue, but oestrogenic effect on the endometrium.
What are some risk factors that aren’t related to unopposed oestrogen?
Type 2 diabetes, hereditary non-polyposis colorectal cancer/Lynch syndrome.
What are protective factors against endometrial cancer?
- COCP
- Mirena
- increased pregnancies
- smoking
How does endometrial cancer present?
- Postmenopausal bleeding
- postcoital bleeding
- intermenstrual bleeding
- menorrhagia
- abnormal vaginal discharge
- anaemia
- haematuria
- raised platelet count
What investigations are used for endometrial cancer?
- Transvaginal USS for endometrial thickness
- Pipelle biopsy
- hysteroscopy with endometrial biopsy.
When is TV USS recommended in women >55?
Unexplained vaginal discharge, visible haematuria plus raised platelets, anaemia or elevated glucose levels.
What is the referral criteria for a 2 week wait?
Postmenopausal bleeding.
What are the stages of endometrial cancer?
- Stage 1: confined to uterus
- Stage 2: invades cervix
- Stage 3: invades ovaries, fallopian tubes, vagina & lymph nodes
- Stage 4: invades bladder, rectum or beyond pelvis.
What is the management for endometrial cancer?
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy for stage 1 and 2
- radical hysterectomy + pelvic lymph nodes removal
- radiotherapy
- chemotherapy
- progesterone may be used as a hormonal treatment to slow progression.
