Uterine Cancer

Question 1

Most common uterine cancer?

Answer 1

Adenocarcinoma

Question 2

What is considered to be a risk factor for endometrial malignancy?

Answer 2

High levels of oestrogen

Question 3

Where do most uterine malignancies arise?

Answer 3

Endometrium

Question 4

Factors which may increase oestrogen?

Answer 4

• PCOS
• Late menopause
• Nulliparity
• Obesity
• Unopposed oestrogen HRT
• Tamoxifen
• Oestrogen secreting tumours

Question 5

What syndrome causes microsatellite instability due to defect in mismatch repair genes and increases risk of colorectal and endometrial cancers?

Answer 5

Lynch syndrome/HNPCC

Question 6

3 forms of endometrial hyperplasia?

Answer 6

Simple
Complex
Atypical

Question 7

When does simple endometrial hyperplasia occur?

Answer 7

Peri-menopausal period

Question 8

What is simple endometrial hyperplasia due to?

Answer 8

-Oestrogen stimulation particularly associated with anovulatory cycles but rarely with oestrogen therapy or oestrogen secreting tumour

Question 9

Clinical presentation of simple endometrial hyperplasia?

Answer 9

Irregular, frequent and heavy bleeding

Question 10

What is atypical endometrial hyperplasia?

Answer 10

Hyperplasia is focal and cytological atypia with mitotic figures

-Considered pre-cancerous and risk of adenocarcinoma developing

Question 11

What are80% of endometrial carcinomas?

Answer 11

Type I cancers:

- Called endometroid tumours

Question 12

What are type I cancers relate to?

Answer 12

Unopposed oestrogen and with atypical hyperplasia

Question 13

What is unopposed oestrogen?

Answer 13

Oestrogen without progesterone

Question 14

What type of cancer includes serous and clear cell cancers?

Answer 14

Type II tumours

Question 15

Endometrial carcinomas are extremely rare. True or false?

Answer 15

False

-Common cancer

Question 16

What is leiomyosarcoma?

Answer 16

Rare malignant uterine tumour of myometrium

Question 17

How does leiomyosarcoma?

Answer 17

• Can arise de novo

- Or from existing leiomyoma (fibroid)

Question 18

Presnetation of endometrial cancers?

Answer 18

• Abnormal uterine bleeding (Principle)
• Vaginal discharge (less common)
• Pain is rarely in early disease

Question 19

Post menopausal bleeding is….?

Answer 19

Malignancy until proven otherwise

Question 20

Investigations for endometrial cancers?

Answer 20

-Transvaginal ultrasound = 1st line
-Endometrial biopsy
0Dilation and curettage
-Hysteroscopy can allow visualization of uterine cavity enabling biopsy/curettage to be done

Question 21

What investigation finding would indicate malignancy is unlikely?

Answer 21

Smooth endometrium <4cm

Question 22

Mainstay management of endometrial cancers?

Answer 22

Hysterecyomy with bilateral salpingo-oophrectomy

Question 23

What treatment can be used adjuvant to prevent reoccurrence?

Answer 23

Radiotherapy

Question 24

What treatment for uterine cancers can be used for candidates unsuitable for surgery?

Answer 24

Radiotherapy

High dose progesterones

Question 25

When would chemo be considered as treatment?

Answer 25

Widespread disease

Question 26

Usual prognosis for uterine cancers?

Answer 26

Good with no recurrence