Flashcards in Endometrial cancer Deck (15):
Where does endometrial carcinomas rank for gynae cancers?
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
What are the risk factors for endometrial cancer?
The main risk factor is the exposure to endogenous and exogenous oestrogen's associated with:
*unopposed oestrogen (HRT)
*hereditary non-polyposis colorectal carcinoma
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
*high grade endometrioid, clear cell, serous or carcinosarcoma cancers
*not oestrogen sensitive
*associated with obesity
What is the premalignant disease of endometrial cancer?
Endometrial hyperplasia with atypia
What is the typical presentation of endometrial cancer?
*Postmenopausal bleeding is the most common presentation
*premenopausal women have irregular or intermenstrual bleeding, or occasionally recent-onset menorrhagia
*pain and discharge unusually features
*pelvis appears normal
*atrophic vaginitis may coexist
What staging is used for endometrial cancer?
Histological grade: G1-G3
Surgical grade: FIGO staging 1 to 4
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
What is the FIGO staging of endometrial cancer?
*Lesions confined to the uterus
*a = < 1/2 of myometrium
*b = > 1/2 of myometrium
*cervical stromal invasion, but not beyond uterus
*Tumour invades through uterus
*a =invades serosa or adnexae
*ci = pelvic node involved
*cii = para-aortic node involved
*a = bowel or bladder
*b = distant metastases
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
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
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
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
What is protective against endometrial cancer?