Endometrial cancer

Endometrial Cancer

Shylasree

Subspec, Gyn Onc

Endometrial cancer

Endometrial cancer

� Referral

� Diagnostics

Endometrial cancer

Referral pathway

� Pre-diagnosis

Who should be referred?

Why ?

Where ?

When ?

Endometrial cancer

Who?

� Postmenopausal bleeding

� Abnormal bleeding in HRT users(see sign guidelines 2002)

� Offensive vaginal discharge

� Abnormal smear suggestive of endometrial cancer

� Others (advanced disease)

Endometrial cancer

HRT Status Current or recent (< 1yr) use of sequential HRT

Never used HRT OR using continuous combined HRT

Estimated pre-test risk of cancer

1-1.5% 10%

Why?

All Women with PMB (not using tomoxifen)

SIGN guidelines 2002

Endometrial cancer

Where ?

� Rapid access PMB clinic

Lead Gynaecologist

Gynaecological oncologist

� Pelvic examination should be done at some stage during their assessment

� Women with a family history conferring risk of EC or EC<40 yrs should be referred to genetics department

Endometrial cancer

When?

� Urgent (two weeks/ 10 working days)

Endometrial cancer

Investigations

� Transvaginal scan

� Hysteroscopy biopsy/pipelle biopsy

Endometrial cancer

HRT Status Current or recent (< 1yr) use of sequential HRT

Never used HRT OR using continuous combined HRT

Estimated pre-test risk of cancer

1-1.5% 10%

All Women with PMB (not using tomoxifen)

SIGN guidelines 2002

Endometrial thickness

< 5mm >5mm

Probability of cancer after test

0.1 – 0.2% 2 –5 %

< 3mm > 3mm

0.6 –0.8% >20 – 22%

Action required No further investigations

Tissue sampling

No further investigations

Tissue sampling

Endometrial cancer

Endometrial cancer

Endometrial cancer

Investigations: Post-diagnosis

� Clinical examination

� Chest X- ray

� Pre-op bloods

Endometrial cancer

MRI

Advantages

� Good practice

� Radiological Staging (which should include upper abdomen)

� Helps in referral to cancer centre or unit

Endometrial cancer

MRI

Disadvantages

� Waiting time

� Who should perform?

� Should they all be discussed in the Centre MDT (time constraints)

� Site specific radiologists? Site specific MDT?

� quality assurance

Endometrial cancer

Investigations

Incomplete surgical staging:

CT imaging is sensible

Endometrial cancer

Referral (post diagnosis)

� All cases with confirmed diagnosis of cancer should receive treatment within 6 weeks of referral

Endometrial cancer

Referral: Post-diagnosis

� All cases greater than stage 1 should be referred to cancer centre

Endometrial cancer

Referral

� Stage 1 (low, intermediate and high risk)

Pre-op confirmation of stage and risk factors: (MRI, Histology)

Who should treat them surgically: cancer centre / cancer unit

What is the best modality of treatment

Endometrial cancer

Thank you