Endometrial cancer Flashcards
what are the two pre cursors for cancer that cause DUB
endometrial polyps and endometrial hyperplasia
1 thing about endometrial polyps
when do they occur
common
around/after menopause
the different types of endometrial hyperplasia and what is it
an increase in glands or an increase in the stroma
simple, complex, atypical (precursor of carcinoma)
what do endometrial polyps cause
non menstrual bleeding
what is the cause for endometrial hyperplasia
unknown
may be persistent oestrogen stimulation
how does someone with endometrial hyperplasia present
abnormal bleeding DUB pre menopausal or post menopausal bleeding
simple hyperplasia
distribution
component
glands
cytology
general distribution
glands and stroma
dilated not crowded
normal cytology
complex hyperplasia
distribution
component
glands
cytology
focal
glands
crowded
normal
atypical hyperplasia
distribution
component
glands
cytology
focal
glands
crowded
atypical
histology of simple hyperplasia
generalised abnormality
cystic dilatation of the glands
cytology normal
histology of complex hyperplasia
relatively small glands
very little stroma - still present tho
nuclei are lined at the bottom of the gland - not atypical
histology of complex atypical hyperplasia
glands are angulated
not much stroma between the glands
nuclei are atypical
chance of complex atypical hyperplasia progressing onto malignancy
25%
age for endometrial cancer
peak 50-60
uncommon <40
what should be considered in young women with endometrial cancer
PCOS or Lynch syndrome
what are the two main groups of endometrial carcinoma and the different precursors for each one
endometrial carcinoma - atypical hyperplasia
serous carcinoma - serous intraepithelial carcinoma
how does endometrial carcinoma present
abnormal bleeding
what does endometrial carcinoma looks like macroscopically
large uterus
polypoid
like a grapefruit
what does endometrial cancer looks like microscopically
most are adenocarcinomas - form glands of the endometrium rather than the stroma
and are usually well differentiated
spread of endometrial cancer
myometrium then into the cervix
lymphatic
haematogenous
Type 1 endometrial cancers
endometriod and mucinous (80%)
related to unopposed oestrogen w/o opposing prog (like in PCOS)
associated with atypical hyperplasia
how is mucinous graded
always low grade
just produced mucin
type 2 endometrial cancers
serous and clear cell
not associated with unopposed oestrogen
elderly post menopausal women
TP53 usually mutated
which kind of endometrial carcinoma is rare
clear cell
Type 1 have what kind of mutations
associated with what
have what kind of instability -
PTEN, KRAS, PIK3CA
atypical hyperplasia as a precursor lesion
micro satellite instability - germline mutation of mismatch repair genes (Lynch)
histology of endometriod cancer
bands of smooth muscle at the bottom
tumour has glands
what is a very big risk factor for endometrial cancer and why
obesity
ovarian androgens are converted into oestrogen which induces endometrial proliferation
who is lynch syndrome considered in
any women under 60
what is lynch syndrome
defective DNA mismatch repair gene
ADom
high risk of colorectal cancer
endometrial cancer
ovarian cancer
what else do lynch tumours show
micro satellite instability MSI - characteristic of defective mismatch repair
how are tumours checked to see if lynch syndrome is present
immunochemistry staining of the tumour for mismatch repair proteins
type 2 tumours are what kind mutation precursor spread what kind is it treatment
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
serous carcinoma histology
characterised by a complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism
what is clear cell carcinoma associated with
only 10% is associated with P53 mutation
what does endometrial cancer usually infiltrate
myometrium
where can serous carcinoma spread
early to the peritoneal cavity
prognosis of endometrioid cancer
usually good as usually confined to uterus at presentation
what does prognosis of endometrial carcinoma depend on
stage
histological grade
depth of myometrial invasion
treatment go endometrial carcinoma
hysterectomy
chemo/radio
endometrioid cancer grading
grade 1 5% or less solid growth. well differentiated
2 6-50% solid growth - poorly differentiated
3 >50% solid growth - aggressive
what are serous carcinoma and clear cell carcinoma graded as
high grade by definition
staging 1A 1B 2 3 3A 3B 3C 4
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
endometrial stromal sarcoma
arises from endometrial sarcoma
types of endometrial stroll sarcoma
low grade
high - increased atypical, proliferative activity, more aggressive
presentation of endometrial stroll sarcoma
abnormal uterine bleeding but initial presentation may be mets - ovary/lung
mets in endometrial stromal sarcoma
even low grade can gets mets
carcinosarcoma
mixed tumour with epithelial and stromal elements
very aggressive
hetereolgous cercinosarcomas
commonly seen in 50% of cases - rhabdomyosarcoma, chrondrosarcoma, osteosarcoma
presence of rhabdomyosarcoma means what
worst prognosis
two types of smooth muscle tumours of the myometrium
leiomyoma - fibroid
leiomyosarcoma
fibroids are what
associated with
very common
associated with menorrhagia, infertility
what is a leiomyosarcoma
malignant smooth muscle tumour displaying spindle cell morphology
age of leiomyosarcomas
symptoms
prognosis
> 50
abnormal vaginal bleeding, palpable pelvic mass, pelvic pain
poor prognosis even if confined to uterus at time of presentation
