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Repro > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

1
Q

what are the two pre cursors for cancer that cause DUB

A

endometrial polyps and endometrial hyperplasia

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2
Q

1 thing about endometrial polyps

when do they occur

A

common

around/after menopause

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3
Q

the different types of endometrial hyperplasia and what is it

A

an increase in glands or an increase in the stroma

simple, complex, atypical (precursor of carcinoma)

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4
Q

what do endometrial polyps cause

A

non menstrual bleeding

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5
Q

what is the cause for endometrial hyperplasia

A

unknown

may be persistent oestrogen stimulation

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6
Q

how does someone with endometrial hyperplasia present

A

abnormal bleeding DUB pre menopausal or post menopausal bleeding

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7
Q

simple hyperplasia

distribution
component
glands
cytology

A

general distribution
glands and stroma
dilated not crowded
normal cytology

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8
Q

complex hyperplasia

distribution
component
glands
cytology

A

focal
glands
crowded
normal

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9
Q

atypical hyperplasia

distribution
component
glands
cytology

A

focal
glands
crowded
atypical

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10
Q

histology of simple hyperplasia

A

generalised abnormality
cystic dilatation of the glands
cytology normal

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11
Q

histology of complex hyperplasia

A

relatively small glands
very little stroma - still present tho
nuclei are lined at the bottom of the gland - not atypical

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12
Q

histology of complex atypical hyperplasia

A

glands are angulated
not much stroma between the glands
nuclei are atypical

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13
Q

chance of complex atypical hyperplasia progressing onto malignancy

A

25%

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14
Q

age for endometrial cancer

A

peak 50-60

uncommon <40

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15
Q

what should be considered in young women with endometrial cancer

A

PCOS or Lynch syndrome

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16
Q

what are the two main groups of endometrial carcinoma and the different precursors for each one

A

endometrial carcinoma - atypical hyperplasia

serous carcinoma - serous intraepithelial carcinoma

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17
Q

how does endometrial carcinoma present

A

abnormal bleeding

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18
Q

what does endometrial carcinoma looks like macroscopically

A

large uterus
polypoid
like a grapefruit

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19
Q

what does endometrial cancer looks like microscopically

A

most are adenocarcinomas - form glands of the endometrium rather than the stroma

and are usually well differentiated

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20
Q

spread of endometrial cancer

A

myometrium then into the cervix
lymphatic
haematogenous

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21
Q

Type 1 endometrial cancers

A

endometriod and mucinous (80%)

related to unopposed oestrogen w/o opposing prog (like in PCOS)
associated with atypical hyperplasia

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22
Q

how is mucinous graded

A

always low grade

just produced mucin

23
Q

type 2 endometrial cancers

A

serous and clear cell

not associated with unopposed oestrogen
elderly post menopausal women
TP53 usually mutated

24
Q

which kind of endometrial carcinoma is rare

A

clear cell

25
Q

Type 1 have what kind of mutations
associated with what
have what kind of instability -

A

PTEN, KRAS, PIK3CA

atypical hyperplasia as a precursor lesion

micro satellite instability - germline mutation of mismatch repair genes (Lynch)

26
Q

histology of endometriod cancer

A

bands of smooth muscle at the bottom

tumour has glands

27
Q

what is a very big risk factor for endometrial cancer and why

A

obesity

ovarian androgens are converted into oestrogen which induces endometrial proliferation

28
Q

who is lynch syndrome considered in

A

any women under 60

29
Q

what is lynch syndrome

A

defective DNA mismatch repair gene
ADom

high risk of colorectal cancer
endometrial cancer
ovarian cancer

30
Q

what else do lynch tumours show

A

micro satellite instability MSI - characteristic of defective mismatch repair

31
Q

how are tumours checked to see if lynch syndrome is present

A

immunochemistry staining of the tumour for mismatch repair proteins

32
Q 
type 2 tumours are what kind
mutation 
precursor
spread
what kind is it
treatment
A

serous and clear cell

TP53 and overexpression

serous endometrial intraepithelial carcinoma

spreads along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease - even if serous cancer only grows on the surface it can still spread up and out into the peritoneum via the fallopian tubes

33
Q

serous carcinoma histology

A

characterised by a complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism

34
Q

what is clear cell carcinoma associated with

A

only 10% is associated with P53 mutation

35
Q

what does endometrial cancer usually infiltrate

A

myometrium

36
Q

where can serous carcinoma spread

A

early to the peritoneal cavity

37
Q

prognosis of endometrioid cancer

A

usually good as usually confined to uterus at presentation

38
Q

what does prognosis of endometrial carcinoma depend on

A

stage
histological grade
depth of myometrial invasion

39
Q

treatment go endometrial carcinoma

A

hysterectomy

chemo/radio

40
Q

endometrioid cancer grading

A

grade 1 5% or less solid growth. well differentiated
2 6-50% solid growth - poorly differentiated
3 >50% solid growth - aggressive

41
Q

what are serous carcinoma and clear cell carcinoma graded as

A

high grade by definition

42
Q 
staging 1A
1B
2
3
3A
3B
3C
4
A

1A - no or <50% mymometrial invasion
1B - invasion equal to or >50% of myometrium
2 - tumour invades cervical stroma
3 - local and or regional tumour spread
3A - tumour invades serosa of uterus and or adnexea
3B - vaginal and/or parametrise involvement
3C - mets to pelvic and/or para aortic LNs
4 - tumour invades bladder or bowel mucosa and or distant mets

43
Q

endometrial stromal sarcoma

A

arises from endometrial sarcoma

44
Q

types of endometrial stroll sarcoma

A

low grade

high - increased atypical, proliferative activity, more aggressive

45
Q

presentation of endometrial stroll sarcoma

A

abnormal uterine bleeding but initial presentation may be mets - ovary/lung

46
Q

mets in endometrial stromal sarcoma

A

even low grade can gets mets

47
Q

carcinosarcoma

A

mixed tumour with epithelial and stromal elements

very aggressive

48
Q

hetereolgous cercinosarcomas

A

commonly seen in 50% of cases - rhabdomyosarcoma, chrondrosarcoma, osteosarcoma

49
Q

presence of rhabdomyosarcoma means what

A

worst prognosis

50
Q

two types of smooth muscle tumours of the myometrium

A

leiomyoma - fibroid

leiomyosarcoma

51
Q

fibroids are what

associated with

A

very common

associated with menorrhagia, infertility

52
Q

what is a leiomyosarcoma

A

malignant smooth muscle tumour displaying spindle cell morphology

53
Q

age of leiomyosarcomas
symptoms
prognosis

A

> 50

abnormal vaginal bleeding, palpable pelvic mass, pelvic pain

poor prognosis even if confined to uterus at time of presentation

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