Makindo Medical Notes

Endometrial cancer, also known as uterine cancer, is the most common gynaecological cancer. It typically originates in the lining of the uterus (the endometrium) and most frequently affects postmenopausal women.

About:

• Cancer arising from the uterine endometrium
• Typically seen in women aged 50-70

Aetiology:

• Raised estrogen levels
• Prolonged exposure to estrogen (longer the period from menarche to menopause)
• Never having a pregnancy
• Older age
• Obesity
• Tamoxifen use for breast cancer
• Family history of colon, ovarian, or breast cancer
• Diabetes

Risk Factors:

• Age: Most cases occur in women over the age of 50.
• Obesity: Increased body fat raises estrogen levels, which is a known risk factor for endometrial cancer.
• Hormone therapy: Estrogen replacement therapy without progesterone can increase the risk.
• Reproductive history: Women who have never been pregnant have a higher risk of endometrial cancer.
• Early menarche and late menopause: Prolonged exposure to estrogen increases the risk.
• Family history: A family history of colon, ovarian, or breast cancer increases the risk.

Clinical Features:

• Vaginal bleeding or discharge, often between periods or postmenopausal bleeding
• Painful intercourse or pelvic pain
• Palpable mass or bulky uterus on pelvic examination

Investigations:

• Blood tests: FBC, U&E, LFTs, CRP
• Transvaginal ultrasound: To examine the pelvis and uterus
• Hysteroscopy: With endometrial biopsy
• Dilation and curettage (D&C): To obtain tissue samples
• Imaging: For endometrioid cancer, CXR and MRI of abdomen/pelvis; for serous, clear cell, or carcinosarcoma types, CT chest/abdomen/pelvis (CAP)

Stages of Endometrial Cancer:

• Stage I: Cancer is found only in the uterus.
• Stage II: Cancer is present in both the uterus and cervix.
• Stage III: Cancer has spread beyond the uterus but hasn't reached the rectum or bladder. Lymph nodes in the pelvic area may be involved.
• Stage IV: Cancer has spread past the pelvic region and can affect the bladder, rectum, or more distant parts of the body.

Management:

• Imaging Stage 1: Hysterectomy with bilateral salpingo-oophorectomy (HYST BSO), +/- nodes if high grade or deep myometrial invasion on MRI
• Imaging Stage 2: HYST BSO +/- nodes (consider radical hysterectomy)
• Imaging Stage 3a: HYST BSO +/- nodes
• Imaging Stage 3b: Individualize treatment
• Imaging Stage 3c1: Pelvic nodes involvement – HYST BSO and nodes (pelvic/PAN)
• Imaging Stage 3c2: Para-aortic node involvement – HYST BSO and nodes (pelvic/PAN) or chemo-radiotherapy followed by surgery
• Imaging Stage 4a: Bowel/bladder involvement – non-surgical management
• Imaging Stage 4b: Best supportive care, hormonal therapy, possible palliative hysterectomy for bleeding
• Type 2 histopathology: Omentum, nodes, and peritoneal washings should be checked
• Urgent gynecological referral: For appropriate surgical or medical intervention
• Surgery: Removal of the uterus (hysterectomy) and ovaries/fallopian tubes (salpingo-oophorectomy) leads to menopause; may include radiotherapy
• Hormonal therapy: To reduce estrogen and raise progesterone levels, slowing cancer progression