Gynae Cancers

Question 1

Significance of CIN grading

Answer 1

CIN1 50-60% will spontaneously regress
CIN 2 - 3-5 % chance or progressing to cancer
CIN 3 20-30% chance of progressing to cancer

Question 2

What’s meant by endometrial hyperplasia?

Answer 2

Irregular overgrowth o endometrial cells, caused by excess unopposed oestrogen. It is a pre-malignant condition.
Described histologically as with or without atypia.

Question 3

Difference between endometrial hyperplasia ± atypia

Answer 3

Without atypia - less than 5% risk of progression to endometrial cancer. Mgmt is address modifiable risk factors - weight loss, and consider progesterone therapy e.g. coil, follow up biopsy every 6months.

With atypia = 25% progress to endometrial cancer.
That risk is too high so the tx is a total abdominal hysterectomy ± BSO( >45yrs).
A conservative approach is patient is keen to avoid surgery is high dose progesterone + 3 monthly follow up.