Endometrial Carcinoma
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Epidemiology

  • The most common genital tract cancer
  • Every year, about 4500 women in the UK develop endometrial cancer
  • The majority (93%) of cases are diagnosed in women aged over 50 years
  • Geographical variation exists – North American: Chinese ratio of about 7: 1

Pathology

  • Adenocarcinoma of the endometrial columnar cellsis the most common type (>90%)
  • Others include adenosquamous carcinoma
  • Pre-malignant disease occurs (endometrial hyperplasia with atypia)

Aetiology

  • High oestrogen / progesterone ratio
  • Nulliparity
  • Late menopause
  • Polycystic ovarian syndrome (if long term amenorrhoea)
  • Obesity
  • Unopposed oestrogens and tamoxifen
  • Diabetes mellitus
  • Family history of breast, ovary or colon carcinoma
  • Combined pill and pregnancy are protective

Clinical features

  • Abnormal vaginal bleeding
  • Postmenopausal bleeding (10% risk of endometrial cancer), usually little and occasional (+/- watery discharge), then bleeding gets heavier and more frequent
  • Premenopausal women get a change in bleeding pattern; irregular, intermenstrual or heavier bleeding

Investigations

  • History – determine if any risk factors are present
  • Examination – bimanual (? abdominal mass)

Postmenopausal

  • USS
  • Biopsy
    • Pipelle or during hysteroscopy
    • If endometrium > 5mm (on USS) or multiple episodes of bleeding

Premenopausal

  • If abnormal or change in periods and >40 yrs of age

Determining cancer spread and fitness for surgery

Staging

Staging is surgico-pathological
  1. In the body of the uterus only
    1. endometrium
    2. <1/2 myometrial invasion
    3. 1/2 myometrial invasion
  2. In the body of uterus and cervix
  3. <Outside uterus, but not outside pelvis
  4. Extending outside the pelvis (bowel and bladder or distant spread)

Treatment

Usually total abdominal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy

  • Radiotherapy if:
    • Lymph nodes positive/likely to be positive
    • Recurrent disease
    • Unfit for surgery
    • Palliative
    • Poor grade

High dose progestogens

  • eg medroxyprogesterone acetate
  • Used in advanced and/or recurrent disease
  • Shrinks the tumour
 

Prognosis

  • Dependent on histology (adenomosquamous poorer prognosis), grade and patient’s fitness
  • Overall 75% 5 year survival
  • Recurrence most common at vaginal vault within 3 years.

References

  • Murtagh’s General Practice. 6th Ed. (2015) John Murtagh, Jill Rosenblatt
  • Oxford Handbook of General Practice. 3rd Ed. (2010) Simon, C., Everitt, H., van Drop, F.
  • Beers, MH., Porter RS., Jones, TV., Kaplan JL., Berkwits, M. The Merck Manual of Diagnosis and Therapy

Read more about our sources

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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