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Endometrial Cancer

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“Endometrial Cancer” © Blausen Medical Communications, Inc. CC BY 3.0 (https://creativecommons.org/licenses/by/3.0/)

The most common type of this is an adenocarcinoma (80%), which is oestrogen-dependent.


The pre-malignant condition of this is Endometrial Hyperplasia, with most going back to normal over time and < 5% going on to become cancer. This is managed with progestogens e.g. Mirena coil or COCP/POP.


This should be the immediate diagnosis to rule out in any women presenting with Postmenopausal bleeding!


Risk factors:

  • Exposure to unopposed oestrogen:

    • Older age

    • Obesity

    • Early menarche

    • Late menopause

    • Nulliparity

    • Oestrogen only HRT

    • PCOS – The lack of ovulation here means there’s less progesterone production from the corpus luteum

    • Tamoxifen – Has an anti-oestrogenic effect on breast, but an oestrogenic effect on endometrium


Protective factors:

  • COCP

  • Mirena coil

  • Increased pregnancies

  • Smoking – as it’s anti-oestrogenic


Presentation

  • Postmenopausal bleeding

  • Intermenstrual bleeding

  • Pelvic pain

  • Menorrhagia

  • O/E - Enlarged uterus


Investigations

  • TVUS – Look for endometrial thickening

  • Pipelle biopsy - This is important to differentiate between hyperplasia and cancer, and is highly sensitive for endometrial cancer, so a -ve result can essentially rule it out.


Management

  • Total hysterectomy w/bilateral salpingo-oopherectomy (TAH + BSO)

  • Progesterone can be used to slow progression of the cancer



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