Uterine Cancer

Question 1

List the primary malignancies of the uterus (3)

Answer 1

Endometrial carcinoma
Carcinosarcomas
Sarcomas

Carcinosarcomas : highly aggressive malignant tumors of the uterus associated with a poor prognosis. Though earlier classified as sarcomas, recent evidence shows that these are high grade endometrial carcinomas with sarcomatous metaplasia

Question 2

Differentiate between type 1 and Type 2 Endometrial cancers of uterus (5/6)

Answer 2

Oestrogen driven vs No oestrogen
Background of hyperplasia vs background of atrophy
Usually 60s vs Older >70s
Oestrogen and progesterone receptor positive vs p53 positive
Less aggressive vs more aggressive
Histology shows endometrioid adenocarcinoma (adrenal glands cancer) vs clear cell and uterine papillary serous cancer

Question 3

Outline the risk factors for type 1 or oestrogen driven uterine cancer (5/6)

Answer 3

1. Obesity
2. Wide oestrogen window early menarche and late menopause
3. Low parity
4. Exogenous oestrogen ie HRT
5. Engogenous oestrigen ie PCOS
6. Family hx

Question 4

How is the diagnosis of endometrial carcinoma made (4)
Hint : Diagnostic tests

Answer 4

Pipelle
Curettage
Hysteroscopy
Endometrial sampling

Question 5

What special investigations would you do for a patient with diagnosis of endometrial cancer (4)

Answer 5

Metastatic screen basically :
Bloods : FBC, UEC, LFT(GGT&ALP)
CXR
CT of abdomen and Pelvis
Mammogram for risk of familial cancer

Question 6

Discuss the management of endometrial carcinomas (endometrial/uterine cancer)

Answer 6

Stage 1 and 2:
-Hysterectomy (Total Abdominal Hysterectomy -TAH)
-Bilateral salpingo-oophorectomy
-Lymph nodes dissection
-Peritoneal washings
-May also require adjuvant chemo if aggressive subtypes

Stage 3 and 4
-Palliative care
-localised radical chemoradiation
-or Hugh dose progesterone (mirena)