Endometrial cancer Flashcards
What is the most common form of endometrial cancer
Adenocarcinoma
What is hyperplasia
An increase in number of cells in a tissue or organ
Suspected diagnosis: Postmenopausal bleeding
Endometrial cancer until proven otherwise
What are the 3 forms of endometrial hyperplasia
Simple
Complex
Atypical (Precursor)
What causes endometrial hyperplasia?
Unopposed oestrogen stimulation
Histological characteristics of simple endometrial hyperplasia
General distribution
Glands and stroma
Dilated
Normal cytology
Histological characteristics of complex endometrial hyperplasia
Focal distribution
Glandular
Crowded
Normal cytology
Histological characteristics of atypical; endometrial hyperplasia
Focal
Glandular
Crowded
Atypical cytology
What are the 2 main groups of endometrial carcinoma
Endometrioid carcinoma and mucinous (Type 1)
Serous carcinoma and clear cell (Type 2)
What is the precursor lesion for endometrioid carcinoma
Atypical endometrial hyperplasia
What is the precursor lesion for endometrial serous carcinoma
Serous intraepithelial carcinoma
Is endometrioid (T1) carcinoma related to unopposed oestrogen?
Yes
What are some mutations common in endometrioid carcinoma (T1)
PTEN
KRAS
PIK3CA
Microsatellite instability (Lynch syndrome)
Is serous carcinoma (T2) associated with unopposed oestrogen?
No
What are some characteristics of serous endometrial carcinoma
Common in early post-menopause
Spreads along fallopian tube mucosa
More aggressive than endometrioid
How is serous carcinoma characterised histologically
complex papillary or glandular architecture with diffuse, marked nuclear pleomorphism
What are some rarer forms of endometrial cancer?
Endometrial stromal sarcoma
Carcinosarcoma
What are some characteristics of endometrial stromal sarcoma
Arises from endometrial storm
Can be low or high grade
Infiltrate myometrium and lymphovascular space
Metastaise to ovary or lung
What are some characteristics of carcinosarcoma
Mixed tumour with malignant epithelial and stromal elements
They have high grade carcinomatous and sarcomatous elements
Other elements such as rhabdomyosarcoma, chondrosarcoma or osteosarcoma are seen in around 50% of cases
These are usually associated with poor outcome
How is endometrial hyperplasia managed?
LNG-IUD (Mirena)
Continuous oral progestogens
What are some risk factors for endometrial cancer?
- Increased age
- Earlier onset of menstruation
- Late menopause
- Oestrogen only hormone replacement therapy
- No or fewer pregnancies
- Obesity
- Polycystic ovarian syndrome
- Tamoxifen
How can PCOS increase endometrial cancer risk
In PCOS, no ovulation occurs, so no corpus luteum forms to produce progesterone
This leads to unopposed oestrogen
What protection is used in people with PCOS to prevent endometrial cancer
- CHC
- Mirena coil
- Cyclical progestogens
What are some examples of cyclical progestogens?
Medroxyprogesterone
Levonorgestrel
How can obesity increase risk of endometrial cancer
Adipose tissue is a source of oestrogen (Especially in post-menopausal women)
The adrenal glands produce testosterone in women
Adipose tissue uses aromatase to convert testosterone into oestrogen
Why does tamoxifen increase risk of endometrial cancer?
It has an anti-oestrogenic effect on the breast tissue but an oestrogen effect on the endometrium
Why does type 2 diabetes increase risk of endometrial cancer?
Increased insulin production stimulates endometrial cell proliferation
What are some protective factors for endometrial cancer
- Combined contraceptive pill
- Mirena coil
- Increased pregnancies
- Cigarette smoking
How is smoking protective of endometrial cancer?
Anti-oestrogenic effect
Increases weight loss decreasing adipose tissue
Destroys oocytes resulting in earlier menopause
How will endometrial cancer present?
Post-menopausal bleeding
Post-coital bleeding
Intermenstrual bleeding
Unusually heavy menstrual bleeding
Abnormal vaginal discharge
Haematuria
Anaemia
Raised platelet count
Referral criteria for 2-week-wait urgent cancer referral for endometrial cancer
Post-menopausal bleeding (>1 year since last menstrual period)
Referral criteria for transvaginal US in those over 55
Unexplained vaginal discharge
Visible haematuria plus raised platelets, anaemia or elevated glucose levels
Investigations required for endometrial cancer
Transvaginal ultrasound - Endometrial thickness
Pipelle biopsy
Hysteroscopy + Biopsy
Normal pre-menopausal endometrial thickness?
<16mm
Normal post-menopausal endometrial thickness
<4mm
How is pipette biopsy performed
Outpatient clinic
Speculum exam plus pipelle (Thin tube) inserted through cervix
FIGO stage 1 endometrial cancer
Confined to the uterus
FIGO stage 2 endometrial cancer
Invades the cervix
FIGO stage 3 endometrial cancer
Invades the ovaries, fallopian tubes, vagina or lymph nodes
FIGO stage 4 endometrial cancer
Invades bladder, rectum, or beyond the pelvis
Management of stage 1 and 2 endometrial cancer
total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO)
What are some other management options for endometrial cancer?
Radical hysterectomy
Radiotherapy
Chemotherapy
Progesterone (Slows growth)
What is a malignant cancer of the myometrium called?
Leiomyosarcoma
Symptoms of leiomyosarcoma?
Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain
Prognosis of leiomyosarcoma
15-25% 5 year survival
