Endometrial Cancer — SAQ

Stem

A candidate is asked to manage a classic presentation of Endometrial Cancer in an exam setting. Use precise definitions, scores, doses, and decision thresholds.

Core knowledge (model answer backbone)

Endometrial cancer is the most common gynaecological malignancy in developed countries and the sixth most common cancer in women. Around 90 per cent present with postmenopausal bleeding, which is cancer until proven otherwise. Two pathogenetic types exist: Type I (endometrioid, 80 per cent) is oestrogen-driven, arising through unopposed oestrogen stimulation, endometrial hyperplasia with atypia and well-differentiated carcinoma, with PTEN, PIK3CA, KRAS and ARID1A mutations and a favourable prognosis; Type II (serous, clear cell, carcinosarcoma, 20 per cent) is not oestrogen-driven, arises in atrophic endometrium, carries TP53 mutations, and is aggressive. Diagnosis is by transvaginal ultrasound (endometrial thickness over 4 to 5 mm in a postmenopausal woman prompts biopsy), pipelle or hysteroscopy and dilation and curettage, and pelvic MRI for myometrial invasion and staging. Treatment is total hysterectomy, bilateral salpingo-oophorectomy, plus sentinel or full lymph node assessment, with adjuvant vault brachytherapy for intermediate risk (PORTEC), external beam radiotherapy and chemotherapy (carboplatin and paclitaxel) for high-risk and advanced disease, and high-dose progestin f

Red flags

• Any postmenopausal bleeding is endometrial cancer until proven otherwise — urgent transvaginal ultrasound and endometrial biopsy
• Endometrial thickness over 4 to 5 mm on TVUS in a postmenopausal woman mandates biopsy
• Atypical endometrial hyperplasia carries a 25 to 40 per cent risk of a coexistent carcinoma and a high progression risk — hysterectomy is definitive
• New vaginal bleeding on tamoxifen requires investigation — tamoxifen roughly doubles endometrial cancer risk

High-yield structure examiners expect

Cover: Overview & Definition, Classification, Epidemiology & Risk Factors, Pathophysiology, Clinical Presentation, Differential Diagnosis.

Key doses / thresholds (from topic teaching)

• Tranexamic acid 1 g intravenously every 8 hours** reduces f
• medroxyprogesterone acetate 200 to 400 mg orally daily, or megestrol acetate 160
• transfuse to a haemoglobin over 80 g/L (or over 100 g/L in symptomatic cardi
• AUC 5 to 6 intravenously plus paclitaxel 175 mg per m² intravenously on day 1, repeated
• Medroxyprogesterone acetate 400 to 600 mg orally daily, or megestrol acetate 160
• Mirena 52 mg) is an alternative

Questions

a) Define the condition and give the most important classification or severity framework used in exams. (3 marks)

• Clear one-line definition matching standard teaching.
• Named classification / stages / types with discriminating features.
• One sentence on why classification changes management.

b) Outline pathophysiology in a mechanism chain that explains the main clinical features. (3 marks)

• Initiating insult → intermediate pathway → end-organ effect.
• Link at least two symptoms/signs to mechanism.
• Mention one complication pathway (e.g. shock, perforation, herniation, arrhythmia).

c) List discriminating clinical features and bedside assessment. (3 marks)

• Classic presentation plus one atypical group (elderly, pregnancy, child, immunocompromised).
• Named signs/manoeuvres if relevant.
• What must never be missed on exam/bedside (pregnancy test, airway, glucose, etc.).

d) Investigations with thresholds and one named score if applicable. (3 marks)

• First-line tests and what positive findings mean.
• Gold-standard or definitive investigation when needed.
• Score components reproduced exactly if a named score is standard for this topic.

e) Immediate resuscitation and definitive management with doses where standard. (3 marks)

• ABC / time-critical steps first.
• First-line drug(s) with agent + dose + route (or procedure steps).
• Escalation triggers (theatre, ICU, thrombolysis window, antidote, etc.).
• Disposition and safety-netting.

Marking tips

Full marks require specificity (numbers, names, doses) not generic "give antibiotics/fluids." Regional practice (ICMR / NICE / AHA) may be cited as alternative where relevant.