endometrial cancer
endometrial carcinoma
gynaecological oncology
uterine cancer
uterus
post menopausal bleeding
endometrial neoplasms
gynaecology
cancer
4. Epidemiology
• UK incidence: 28/100,000
• 9,000 new UK cases in 2013
• The fourth most common cancer in women in the UK , after breast (31%), lung (12%), bowel
(11%), and more common now than cervical cancer*
• Incidence on the rise in post menopausal European women
• Marked geographical variation: North American: Chinese ratio ≈7:1
5. Aetiology & risk factors
Unopposed oestrogen exposure hypothesis
• Age
• Nulliparity
• Early menarche & late menopause
• HRT
• Obesity & the metabolic syndrome; PCOS
But not
• Combined oral contraceptive
6. Histology
• Classically, endometrial carcinomas have been split into two types based on histological
findings:
• Type 1 “endometrioid” carcinomas are well differentiated (grade 1), hormone receptor positive
neoplasms, typically with a good prognosis. Is generally thought to be preceded by endometrial
hyperplasia, but there is additional dysregulation of the PI3KCA/ AKT signalling pathway, and the
histological pattern of hyperplasia is atypical. Affects women aged 55-65 yrs. Accounts for
around 80% of endometrial adenocarcinomas.
• Type 2 carcinomas are poorly differentiated (grade 3), aneuploid, hormone receptor negative
neoplasms, typically with a poor prognosis. TP53 loss of function. Arises in the setting of
endometrial atrophy, and can be subdivided into serous and clear cell types. Affects women
aged 65-75 yrs. 20% of endometrial carcinomas.
9. Clinical presentation
More common in post menopausal women (75%)
• PMB- always a red flag symptom; 1 in 5 PMB’s are due to malignancy
Pre- or perimenopausal women (25%)
• IMB & menorrhagia
10. Clinical presentation- History
PMHx
• Breast cancer, diabetes mellitus, Lynch syndrome
Menstrual & gynaecological hx
• Early menarche/ late menopause
• Known endometrial hyperplasia
• Parity
DHx
• HRT, tamoxifen, contraception
12. Workup
Transvaginal ultrasound- measurement of endometrial thickness; greater than 4-5mm?
Biopsy- endometrial sampling as outpatient
• Pipelle or Vabra cannula (99% and 97% sensitivity; PPV 81%)
• Sample all parts of the uterus
Hysteroscopy & biopsy- only if minimally invasive sampling fails
Dilatation & curettage- no longer performed
13. Workup (cont.)
• Bloods (FBC, LFT’s, U&E’s)
• CXR
• CT/ MRI
Staging (FIGO system)
I- in the body of the uterus only (80%)
II- in the body and the cervix only
III- spread beyond the uterus, but not the pelvis
IV- beyond the pelvis
NICE diagnostic algorithm
22. Part 1 - Summary
• Often preceded by endometrial hyperplasia; proliferation encouraged by unopposed action of
oestrogen
• Clinically presents as post menopausal bleeding; must always be investigated
• Diagnosed by transvaginal US & endometrial sampling in outpatients; bloods, CXR, CT, MRI for
staging
• Staged using the FIGO system
• Surgical therapies: hysterectomy & lymphadenectomy
• Medical therapies: radiotherapy, chemotherapy, hormone therapies
• Choice of therapy depends on the stage & grade of tumour & risk stratification