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Endometrial cancer (Risk factors (Nullparity, Obesity, Late menopause,…
Endometrial cancer
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Clinical
presentation
Menstrual disturbance
(heavy, irregular)
Abnormal bleeding
(IMB, PMB)
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Diagnosis
Investigations
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Imaging
USS: endometrial thickness >4mm
Hysteroscopy: visualisation if
abnormal USS or persistent bleeding
CXR: staging
CT chest/abo/pelvis: staging
MRI pelvis: local extent (not routine)
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Examination
Abdominal: cachexia, masses (unlikely)
Pelvic: masses, blood/discharge
Speculum: blood, discharge, masses
History
PGH
Known conditions, menses,
bleeding, contraception/HRT, STIs, smears
POH
Gravity/parity, conception, delivery,
complications
PC/HPC
Abnormal bleeding, discharge,
weight loss, night sweats
PMH
Known conditions, surgeries
DH
Current meds, allergies
SH
Occupation, smoking, alcohol,
social support
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Staging (FIGO)
Stage 2
Uterus and cervix, or cervical stroma
Stage 3
Extension to uterine serosa, peritoneal cavity,
lymph nodes, anexae, vagina
Stage 1
Limited to uterus, low depth
Stage 4
Extension beyond pelvis or bladder/bowel
involvement, distant metastases
Pathophysiology
High oestrogen
Increased unopposed oestrogen levels (endogenous or exogenous)
Oestrogen stimulates proliferation of endometrial tissue
Parity and COCP are protective, as high progesterone effect
Histology
Adenocarcinoma (commonest, 90%)
Adenosquamous (5%)
Other e.g. clear cell, papillary serious
Grading
GI (well diff), G2 (moderate), G3 (poor/high risk)
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Management
Medical
Adjuvant RT
Indication: high risk/advanced disease, palliation for symptoms
E.g. external beam, brachytherapy
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Adjuvant hormonal
Indication: palliation for symptoms, recurrent disease
E.g. progestrogens
Surgical
Hysterectomy
MOA: total abdo hysterectomy, BSO
and pelvic washout; or laparoscopic
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Conservative
Information, advice, support
Cancer specialist nurse
Epidemiology
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Increasing incidence
(ageing, obesity, diagnosis)
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