Endometrial cancer Flashcards Preview

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Flashcards in Endometrial cancer Deck (15):
1

Where does endometrial carcinomas rank for gynae cancers?

Most common

2

What is the epidemiology of endometrial cancer?

*cumulative risk with age
*Prevalence highest at age 60
*classically seen in post-menopausal women
*only 15% occurring pre-menopausally

3

What are the risk factors for endometrial cancer?

The main risk factor is the exposure to endogenous and exogenous oestrogen's associated with:
*Obesity
*Nulliparity
*Early menarche
*late menopause
*unopposed oestrogen (HRT)
*diabetes mellitus
*tamoxifen
*PCOS
*hereditary non-polyposis colorectal carcinoma

4

What two subtypes is endometrial cancer divided into, on the basis of histology?

Type 1 (majority):
*Low grade endometrioid cancers, which are oestrogen sensitive
*associated with obesity
*usually less aggressive
*atypia as precursor

Type 2:
*high grade endometrioid, clear cell, serous or carcinosarcoma cancers
*more aggressive
*not oestrogen sensitive
*associated with obesity

5

What is the premalignant disease of endometrial cancer?

Endometrial hyperplasia with atypia

6

What is the typical presentation of endometrial cancer?

History
*Postmenopausal bleeding is the most common presentation
*premenopausal women have irregular or intermenstrual bleeding, or occasionally recent-onset menorrhagia
*pain and discharge unusually features

Examiantion
*pelvis appears normal
*atrophic vaginitis may coexist

7

What staging is used for endometrial cancer?

Histological grade: G1-G3
Surgical grade: FIGO staging 1 to 4

8

What is the histological grading of endometrial cancer?

Grade (G) 1-3
G1: well differentiated tumour
G2: cells are moderately differentiated
G3: cells are poorly differentiated

9

What is the FIGO staging of endometrial cancer?

Stage 1:
*Lesions confined to the uterus
*a = < 1/2 of myometrium
*b = > 1/2 of myometrium

Stage 2:
*cervical stromal invasion, but not beyond uterus

Stage 3:
*Tumour invades through uterus
*a =invades serosa or adnexae
*b =vagina
*ci = pelvic node involved
*cii = para-aortic node involved

Stage 4:
*Further spread
*a = bowel or bladder
*b = distant metastases

10

What investigations should be done for someone with postmenopausal bleeding?

*If over the age of 55, then 2 week urgent referral
*TV USS looking for normal endometrial thickness of <4mm (high negative predictive value
*Hysteroscopy with endometrial biopsy

11

What extra investigations should be ordered when endometrial carcinoma found?

*MRI may be used to give an estimate of myometrial invasion
*Chest X-Ray to exclude rare pulmonary spread
*Assess patient fitness in elderly: FBC, U&Es, glucose test, ECG

12

What marker is used as a high negative predictor when doing a transvaginal USS for suspected endometrial carcinoma?

*Endometrial thickness <4mm =high negtive predictor of cancer

13

What is the treatment of endometrial carcinoma?

*Unless patient unfit/disseminated disease, a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy performed
*if high risk disease patient has post-op external beam radiotherapy
*progesterone therapy can be used for frail elderly women that are not suitable for surgery

14

What is protective against endometrial cancer?

*COCP
*Pregnancy

15

How common are uterine sarcomas? Also know as?

*Rare, 150 cases per year
*Also called leiomyosarcomas = 'malignant fibroids'