72. Uterine cancer. Uterine sarcoma. Early detection of endometrial pre-cancer and cancer.

Question 1

what are the types of uterine cancer ?

Answer 1

endometrial cancer and

uterine sarcoma

Question 2

what are the causes for uterine cancer ?

Answer 2

type 1 - estrogen dependant
Nulliparity
Early menarche and late menopause
Polycystic ovary syndrome
Metabolic syndrome (esp. obesity and diabetes mellitus type 2 )
Unopposed estrogen replacement therapy (e.g., for menopausal symptoms)
History of breast cancer and tamoxifen treatment
Lynch syndrome (hereditary nonpolyposis colorectal cancer)

cowden syndrome- AD - autosomal dominat syndrome- causes multiple hamartoma

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type 2 - estrogen indpendan gentic predisposition - p53 mutation
BRCA1 and bRCA2
smoking

Question 3

what are the symptoms of endometrial cancer ?

Answer 3

vaginal bleeding or spotting after menopause - esp common in adenocarcinoma (highest incidence)

Abnormal menstrual cycles or extremely long, heavy, or frequent episodes of bleeding in women before menopause

Symptoms other than bleeding are not common.

More advanced disease shows more obvious symptoms:
uterus enlargened
spreading of cancer lower abdominal pain and pelvic cramping
weight loss

Question 4

what is the diagnosis of endometrial cancer ?

Answer 4

transvaginal ultrasound

hysteroscopy and biopsy

Question 5

what are the different types of endometrial cancer ?

Answer 5

endometrial mucinous adenocarcinoma - type 1

uterine papillary serous carcinoma (contain psamomma bodies ) - type 2

uterine clear cell adenocarcinoma - type 2

Mixed or undifferentiated carcinoma - mullein tumors - type 2

Question 6

uterus carcinoma are classified into type 1 and type 2 carcinoma according to?

Answer 6

Type I endometrial carcinomas occur most commonly before and around the time of menopause
often low-grade, minimally invasive into the underlying uterine wall
estrogen-dependent

type 2
usually occur in older, post-menopausal people
not associated with increased exposure to estrogen
often high-grade, with deep invasion into the underlying uterine wall (myometrium), are of the serous or clear cell type, and carry a poorer prognosis.

Question 7

Mixed or undifferentiated carcinoma describe main features ?

Answer 7

contain epithelial and sarcomatous tissue

worst prognosis

Question 8

what is used to stage the endometrial cancer ?

Answer 8

a computerized tomography (CT) scan,

positron emission tomography (PET) scan and blood tests

Question 9

what is the staging for endometrial cancer

Answer 9

FIGO staging

Tis - carcinoma in situ

1 - tumor confined to uterus
a = <50 myometrial invasion
b - 50 and more

2-
a - endocervical gland
b - cervical stroma

3a - tumor invades serosa / adnexa
3b- vagina or parametric involvement
3c - pelvic lymph node involvement
or para aortic lymph involvement

4a - tumor invades bladder mucosa / bowel mucosa
4b - distant metastasis such as inguinal lymph nodes

Question 10

what are the treatment for endometrial cancer ?

Answer 10

operation to remove the uterus (hysterectomy), as well as to remove the fallopian tubes and ovaries (salpingo-oophorectomy) with lymphadenoectomy

after surgery chemotherapy and radiation therapy

Progestins: Indicated for women with early stage endometrial carcinoma (well-differentiated and progesterone and estrogen receptor positive)
and as adjuvant therapy
and want to preserve fertility

Question 11

what is uterine sarcoma ?

Answer 11

malignant tumors that arise from the smooth muscle or connective tissue of uterus

Question 12

what are the signs and symptoms of uterine sarcoma ?

Answer 12

Unusual or postmenopausal bleeding
pelvic pain and pressure
unusual discharge

Question 13

what is the histology of uterine sarcoma ?

Answer 13

if the lesion originates from the endometrial lining - endometrial stromal sarcoma

originating from myometrium - uterine leiyomyosarcoma

carcinosarcoma/ mixed /mullerian tumor - consist
malignant epithelial and sarcomatous components

Question 14

how is uterine sarcoma diagnosis ?

Answer 14

obtain tissue biopsy through hysteroscopy

do an ultrasound , ct scan , Pet scan

Question 15

describe the leiyomyosarcoma ?

Answer 15

they very very rarely arise from lieyomyoma (benign tumor)

tumor is usually hemorrhagic , pleomorphic cells and coagulative tumor cell necrosis

Question 16

how is the diagnosis of leiomyosarcoma made?

Answer 16

ct scan and PET scan

hysteroscopy and tissue biopsy

Question 17

what is the staging of leiyomyosarcoma ?

Answer 17

FIGO

stage 1 - limped to uterus
steage 2 - tumor extends beyond uterus but within pelvis - adnexa or pelvic tissues

stage 3 - infiltrates abdominal tissues
stage 4 a - invades bladder or rectum
4b - distant metastasis such as inguinal lymph nodes

Question 18

what is the staging in mixed mullein tumor?

Answer 18

same as for endometrial cancer

Question 19

what is the treatment for leiyomyosarcoma ?

Answer 19

surgery s the mainstream therapy - hysterectomy , salpingooophorectomy

after that radiation therapy and chemotherapy

usually the prognosis is very poor

Question 20

prevention of endometrial cancer

Answer 20

Low estrogen and high progestin or progesterone levels have a protective effect.
Multiparity 
Combination oral contraceptive pills
Regular physical exercise 
Lifelong soy-rich diet  

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Women with Lynch syndrome should begin to have annual biopsy screening at the age of 35.