Endometrial cancer

Question 1

How can post-menopausal bleeding (PMB) be investigated?

Answer 1

Pelvic and speculum exam
TVUS
Endometrial biopsy

Question 2

What is a TVUS?

Answer 2

Trans vaginal ultrasound

Question 3

What does a TVUS investigate?

Answer 3

Endometrial thickness

Endometrial contour

Question 4

When would you perform an endometrial biopsy?

Answer 4

If endometrial thickness on TVUS >4mm or irregular

Question 5

What is a TLH?

Answer 5

Total laparoscopic hysterectomy

Question 6

What is a BSO?

Answer 6

Bilateral salpingoophorectomy

Question 7

What are peritoneal washings?

Answer 7

Salt-water solution is used to wash the peritoneal cavity and then is removed to check for cancer cells

Question 8

What are pathological prognostic features used in endometrial cancer?

Answer 8

Histological type
Histological grade
Stage
LVSI

Question 9

What is LVSI?

Answer 9

Lymphovascular space invasion

Question 10

Why is LVSI important in endometrial cancer?

Answer 10

Independent risk factor for pelvic lymph node metastasis and is present in about 15% of early-stage endometrial cancers

Question 11

How is staging done for endometrial cancer?

Answer 11

Surgical/pathological

MRI

Question 12

What does the MRI investigate for staging of endometrial cancer?

Answer 12

Depth of myometrial invasion
Cervical involvement
Lymph node involvement

Question 13

What is the staging system for endometrial cancer?

Answer 13

FIGO 2009

Question 14

What does stage 1A FIGO 2009 mean?

Answer 14

Inner half of myometrium

Question 15

What does stage 1B FIGO 2009 mean?

Answer 15

Outer half of myometrium

Question 16

What does stage 2 FIGO 2009 mean?

Answer 16

Invades cervix

Question 17

What does stage 3A FIGO 2009 mean?

Answer 17

Serosa/adnexa

Question 18

What does stage 3B FIGO 2009 mean?

Answer 18

Vagina/parametrium

Question 19

What does stage 3C FIGO 2009 mean?

Answer 19

Pelvic or para-aortic nodes

Question 20

What does stage 4 FIGO 2009 mean?

Answer 20

Bladder/bowel/intra-abdominal/inguinal nodes

Question 21

What are the two distinct categories of endometrial cancer?

Answer 21

Type 1

Type 2

Question 22

What is Type 1 endometrial cancer?

Answer 22

Endometrioid adenocarcinoma

Question 23

What is Type 2 endometrial cancer?

Answer 23

Uterine serous & clear cell carcinoma

Question 24

What is the most common type of endometrial cancer?

Answer 24

Type 1 endometriosis adenocarcinoma

Question 25

What type of endometrial cancer is high grade, more aggressive and has a worse prognosis?

Answer 25

Type 2 - uterine serious & clear cell carcinoma

Question 26

Which age group tends to get Type 2 endometrial cancer?

Answer 26

Older women

Question 27

What is unopposed oestrogen?

Answer 27

Oestrogen produced post menopause, unopposed oestrogen causes the cells of the endometrium to divide, which can increase the risk of womb cancer

Question 28

What are Type 1 endometrial cancers linked to?

Answer 28

Excess oestrogen

Question 29

What is the treatment of early stage endometrial cancer?

Answer 29

Surgery | TAH/BSO/washings

Question 30

What is the treatment of advanced stage endometrial cancer?

Answer 30

Radiotherapy

Question 31

What is used during palliation of endometrial cancer?

Answer 31

Progesterone

Question 32

What is the treatment of endometrial cancer if there is high risk histology?

Answer 32

Chemotherapy

Question 33

When does endometrial cancer tend to develop in women?

Answer 33

Post-menopause High circulating oestrogen levels Atypical endometrial hyperplasia Genetic: HNPCC/Lynch syndrome

Question 34

What can cause high circulating levels of oestrogen?

Answer 34

Obesity Unopoosed E2 therapy/tamoxifen PCOS Early menarche/late menopause

Question 35

How can Tamoxifen cause endometrial cancer?

Answer 35

Tamoxifen acts as an anti-estrogen in breast tissue, but it acts like an estrogen in the uterus. In women who have gone through menopause, it can cause the uterine lining to grow, which increases the risk of endometrial cancer.

Question 36

What are the main symptoms of endometrial cancer?

Answer 36

Abnormal vaginal bleeding | Post menopausal bleeding (PMB)

Question 37

What percentage of women with PMB will have endometrial cancer?

Answer 37

8%

Question 38

What else can cause PMB?

Answer 38

``` HRT Peri-menopausal bleeding Atrophic vaginitis Polyps cervical/endometrial Other cancer: cervix, vulva, bladder, anal ```

Question 39

Are older or younger women more likely to get endometrial cancer?

Answer 39

Older

Question 40

What is the main treatment for endometrial cancer?

Answer 40

TAH and BSO - and peritoneal washings

Question 41

How is the main diagnosis of endometrial cancer done?

Answer 41

Histological

Question 42

What are risk factors for endometrial cancer?

Answer 42

``` High oestrogen/progesterone ratio Nulliparity Late menopause PCOS Obesity Unopposed oestrogens and tamoxifen DM FH breast, ovary or colon ```

Question 43

What are protective factors for endometrial cancer?

Answer 43

OCP | Pregnancy

Question 44

What are the investigations for endometrial cancer?

Answer 44

USS | Biopsy