Endometrial Carcinomas

Question 1

What are the different classes of endometrial carcinomas?

Answer 1

• Type 1 – Endometrioid adenocardinoma
  
  • Commonest
  • Hyperplasia with atypia precurser
• Type 2 – uterine serous and clear cell carcinoma
  
  • High grade, worse prognosis
  • Older woman
  • Serous intraepithelial carcinoma precursor

Question 2

Which class of endometrial carcinomas has worse prognosis?

Answer 2

• Type 1 – Endometrioid adenocardinoma
  
  • Commonest
  • Hyperplasia with atypia precurser
• Type 2 – uterine serous and clear cell carcinoma
  
  • High grade, worse prognosis
  • Older woman
  • Serous intraepithelial carcinoma precursor

Question 3

Which class of endometrial carcinoma is commonest?

Answer 3

• Type 1 – Endometrioid adenocardinoma
  
  • Commonest
  • Hyperplasia with atypia precurser
• Type 2 – uterine serous and clear cell carcinoma
  
  • High grade, worse prognosis
  • Older woman
  • Serous intraepithelial carcinoma precursor

Question 4

What is the precurser for type 1 and type 2 endometrial carcinoma?

Answer 4

• Type 1 – Endometrioid adenocardinoma
  
  • Commonest
  • Hyperplasia with atypia precurser
• Type 2 – uterine serous and clear cell carcinoma
  
  • High grade, worse prognosis
  • Older woman
  • Serous intraepithelial carcinoma precursor

Question 5

Which class of endometrial carcinoma affects older woman?

Answer 5

• Type 1 – Endometrioid adenocardinoma
  
  • Commonest
  • Hyperplasia with atypia precurser
• Type 2 – uterine serous and clear cell carcinoma
  
  • High grade, worse prognosis
  • Older woman
  • Serous intraepithelial carcinoma precursor

Question 6

How is the classification of endometrial carcinomas likely to change in the future?

Answer 6

Classification is changing, in future likely to be based on molecular findings:

• Molecular testing on tumour tissue to look for certain mutations and genetic aberrations such as P53 mutations or microsatellite instability

Question 7

What are risk factors for endometrial carcinoma?

Answer 7

• High circulating oestrogen levels
  
  • Obesity
  • Unopposed E2 therapy
  • Polycystic ovarian syndrome
  • Early menarche/early menopause
• Endometrial hyperplasia with atypia
• HNPCC/Lynch type II familial cancer syndrome
• Post-menopausal
• Hypertension
• Diabetes

Question 8

Where does endometrial cancer rank in womans cancers prevalence?

Answer 8

• Uterine cancer in 4^th place
• Ovarian cancer in 6^th place
• (most common is breast, then lungs, then bowel)

Question 9

Describe the presentation of endometrial carcinoma?

Answer 9

• Abnormal vaginal bleeding
  
  • Post-menopausal bleeding (PMB) for most woman
  • Intermenstrual or heavy bleeding for people with family history of HNPCC
• Pain with urination or sexual intercourse
• Pelvic pain

Question 10

What investigations are done for endometrial carcinoma?

Answer 10

• Trans-vaginal USS
  
  • Measure endometrial thickness and look at contour
    
    • Biopsy if >4mm or irregular
• Endometrial biopsy
  
  • Such as pipelle endometrial biopsy
• Hysteroscopy
  
  • Done if not possible to do pipelle endometrial biopsy or suspicion of underlying pathology
• MRI
  
  • Used for staging – depth of myometrial invasion, cervical involvement and lymph node involvement

Question 11

How is staging of endometrial cancer done?

Answer 11

Staging is done by surgical/pathological means and MRI

Question 12

What are the different stages of endometrial carcinoma?

Answer 12

Question 13

Describe the management for endometrial carcinoma?

Answer 13

• Early stage
  
  • Total laparoscopic hysterectomy
  • Bilateral salpingoophorectomy
  • With peritoneal washings
• High risk
  
  • Chemotherapy
• Advanced stage
  
  • Radiotherapy
• Palliation
  
  • Progesterone

Question 14

What does the prognosis of endometrial carcinoma depend on?

Answer 14

• Depends on
  
  • Histological type
  • Histological grade
  • Stage
  • Lymphovascular space invasion (LVSI)
• Cure rates for each stage
  
  • IB – 85%
  • IIA – 75%
  • IIB – 60%
  • IIIB – 30%
  • IV – 21%