Endometrial cancer

Question 1

If there is post-menopausal bleeding which investigations would be carried out in the post-menopausal bleeding clinic?

What are you looking for?

Answer 1

1) Pelvic and speculum examination

2) Trans-vaginal ultrasound scan:
- Measure endometrial thickness
- Looks at the endometrial contour
- Biopsy if >4mm or irregular

3) Endometrial biopsy:
- E.g. Pipelle

4) Hysteroscopy:
- Out patient with local
- In patient with general

Endometrial cancer

Question 2

Which pathological prognostic features are there for endometrial cancer?

Answer 2

1. Histological type
2. Histological grade
3. Stage
4. LVSI

Question 3

How would you confirm endometrial cancer and stage?

Answer 3

Confirmation:

1) Ultrasound
2) Endometrial biopsy

Staging:
1) Surgical/Pathological

2) MRI
- Depth of myometrial invasion
- Cervical involvement
- Lymph node involvement

Question 4

Endometrial cancer staging - Stage 1a?

Answer 4

Inner half of myometrium

Question 5

Endometrial cancer staging - Stage 1b?

Answer 5

Outer half of myometrium

Question 6

Endometrial cancer staging - Stage 2?

Answer 6

Invades cervix

Question 7

Endometrial cancer staging - Stage 3a?

Answer 7

Serosa/adnexa

Question 8

Endometrial cancer staging - Stage 3b?

Answer 8

Vagina/parametrium

Question 9

Endometrial cancer staging - Stage 3c?

Answer 9

Pelvic or para-aortic nodes

Question 10

Endometrial cancer staging - Stage 4?

Answer 10

Bladder/bowel/intra-abdominal/inguinal nodes

Question 11

What are the two distinct categories of endometrial cancer?

Answer 11

1) Type 1 = Endometrioid adenocarcinoma (Hyperplasia)

2) Type 2 = Uterine serous and clear carcinoma (Sporadic)

Question 12

Which category of endometrial cancer is the most common?

Answer 12

Type 1 = Endometrioid adenocarcinoma (Hyperplasia) = 75% case

Question 13

What is the average age of presentation of type 1, Endometrioid adenocarcinoma (Hyperplasia)?

Answer 13

60 years old

Question 14

What is the average age of presentation of type 2, Uterine serous and clear carcinoma (Sporadic)?

Answer 14

70 years old

Question 15

Histology of type 1 endometrial cancer?

Answer 15

Endometrioid (normal epithelium like) adenocarcinoma

Question 16

Histology of type 2 endometrial cancer?

Answer 16

Uterine serous and is characterised by papillary structures with psammoma body formation

Question 17

Which mutation is common within type 2, Uterine serous and clear carcinoma (Sporadic)?

Answer 17

p53 mutation

Question 18

Which type of endometrial carcinoma is more aggressive?

Answer 18

Type 2, Uterine serous and clear carcinoma is high grade, more aggressive, and has a worse prognosis

Question 19

Which type of endometrial cancer is stimulated by oestrogen exposure?

Answer 19

Type 1, Endometrioid adenocarcinoma (Hyperplasia)

Question 20

What risk factors are there for type type 1, Endometrioid adenocarcinoma (Hyperplasia)?

Answer 20

Oestrogen exposure so:
1) Early menarche/late menopause

2) Nulliparity
3) Infertility with anovulatory cycles
4) Obesity
5) Unopposed E2 therapy/Tamoxifen
6) Polycystic ovarian syndrome (PCOS)
7) HNPCC/Lynch type II familial cancer syndrome
8) Endometrial hyperplasia

Question 21

Treatment of endometrial cancer - Early cancer?

Answer 21

Surgery TAH/BSO/washings

Question 22

Treatment of endometrial cancer - high risk histology?

Answer 22

Chemotherapy

Question 23

Treatment of endometrial cancer - advance stage?

Answer 23

Radiotherapy - External beam

Question 24

Treatment of endometrial cancer - Palliation?

Answer 24

Progesterone

Question 25

Treatment of endometrial cancer?

Answer 25

1) Early = Surgery TAH/BSO/washings 2) High risk histology = Chemotherapy 3) Advanced stage = Radiotherapy 4) Palliation = Progesterone Others: > Caesium insertion: - Intra-cavity - Vault

Question 26

Endometrial cancer cure rates - Stage 1b?

Answer 26

85%

Question 27

Endometrial cancer cure rates - Stage 2a?

Answer 27

75%

Question 28

Endometrial cancer cure rates - Stage 2b?

Answer 28

60%

Question 29

Endometrial cancer cure rates - Stage 3b?

Answer 29

30%

Question 30

Endometrial cancer cure rates - Stage 4?

Answer 30

21%

Question 31

What are the symptoms of endometrial cancer?

Answer 31

> Abnormal vaginal bleeding > Post menopausal bleeding

Question 32

What are the rates of endometrial cancer in post-menopausal bleeding?

Answer 32

8% of women with PMB will have endometrial cancer

Question 33

What are the causes of post-menopausal bleeding?

Answer 33

1) Endometrial cancer 2) Hormone replacement therapy 3) Peri-menopausal bleeding 4) Atrophic vaginitis 5) Polyps cervical/endometrial 6) Other cancers e.g. cervix, vulva, bladder, anal

Question 34

Incidence of endometrial cancer in the UK?

Answer 34

> 9234 new cases in 2014 > 29.8 per 100,000 > 1% per 100,000 women aged 40

Question 35

Deaths from endometrial cancer in the UK?

Answer 35

> 2166 deaths in 2014 > 6.7 per 100,000 women

Question 36

5 year survival rates of endometrial cancer overall?

Answer 36

78%

Question 37

5 year survival rates of endometrial cancer overall - Stage 1?

Answer 37

95%

Question 38

5 year survival rates of endometrial cancer overall Stage 4?

Answer 38

14%

Question 39

What is the main treatment for endometrial cancer?

Answer 39

Total abdominal hysterectomy with removal of tubes (salpingectomy) and peritoneal washing