Endometrial Cancer Flashcards
What is the peak age for endometrial cancer?
50-60 years
If you get Endometrial cancer when you are young, there is likely an underlying predisposition. What could this be?
Lynch Syndrome
PCOS
How does endometrial caner generally present?
Abnormal bleeding
TRUE/FASLE Endometrial cancers are mostly adenocarcinomas
TRUE
Spread of endometrial cancer can be by three ways- what are they?
Lymphatic
Haematogenous
Directly into myometrium and cervix
What are the two main subtypes of endometrial cancer?
Type 1 tumours- Endometrioid (and mutinous)
Type 2 tumours- Serous (and clear cell)
What is the difference in endometrial glands between pre and post menopausal?
Pre- lots of endometrial gland
Post- Thin layer
What are type 1 tumours related to?
Unopposed oestrogen
What is a precursor lesions of endometriosis cancers
Atypical hyperplasia
A germline mutation of mismatch repair genes describes which syndrome?
Lynch syndrome
Which 3 cancers is there an increased risk of with Lynch syndrome?
Endometrial
Ovarian
Colorectal
Why is obesity a RF for endometrial cancer?
Endocrine/inflammatory effects of adipose tissue
Adipocytes express ——— that converts ovarian androgens into ——–, which induces endometrial hyperplasia
aromatase
oestrogens
If you lose weight is your risk of endometrial cancer reduced?
YES, YES IT IS
Why is PCOS a risk factor for endometrial cancer type 1?
As they don’t ovulate they don’t produce progesterone
TRUE/FALSE Endometrioid cancer is usually confined to the uterus at presentation therefore there is a good prognosis
TRUE
How are endometrioid cancers primarily graded?
By architecture- amount of glandular differentiated
ALL endometrial cancers are formally graded TRUE/FALSE
Endometriod (and mutinous) are
Serous (and clear cell) carcinomas are not formally graded
What percentage of endometrial cancers are type 1?
80%
What is stage 1 of endometrioid cancer grading?
Confined to the body of the uterus
What is stage 2 of endometrioid cancer grading?
Body and cervix only
What is stage 3 of endometrioid cancer grading?
Advancing beyond uterus, not belong pelvis
What is stage 4 of endometrioid cancer grading?
Extending outside pelvis
What are the two types of Type 2 tumours?
Serous (and clear cell)
What are type 2 tumours characterised by?
Complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism
What type of women does serous tumours effect?
Elderly post-menopausal women
In serous tumours of the endometrium what is often mutated / over expressed?
TP53
What is the precursor lesion for serous endometrial cancers?
Serous endometrial intraepithelial carcinoma
Serous carcinoma can spread along the Fallopian tube mucosa and peritoneal surfaces, therefore it can present with…
extrauterine disease
Which is the more aggressive type of endometrial cancer?
Type 2- (serous, clear cell)
Treatment of endometrial cancer
TAH with BSO and peritoneal washings
What additional treatment could you give if it was advanced disease?
High-dose progesterone for palpation of symptoms
External beam radiotherapy to control bleeding
What is the follow up on endometrial cancer?
2 years if grade 1
5 years if grade 2/3
How does endometrial stromal sarcoma present?
AUB
Metastasis
ALL endometrial cancers share the same staging system TRUE/FALSE
FALSE
- Endometriod cancer and carcinosarcoma share a staging system
- Leiomyosarcoma and endometrial stromal sarcoma share the same staging system (different to endometrial cancer)
- Serous carcinomas and clear cell carcinomas are not formally graded
What are leiomyosarcoma affectionately known as?
Fibroids
Which particular population are leionyosarcomas common in?
Afro carribean Women >40 years
Leiomyosarcoma growth is dependent on what?
Oestrogen
What are leiomyosarcoma associated with?
Menorrhagia, Infertility
Usually leiomyosarcoma are an incidental finding, when do they cause problems?
When they are submucosal as they stretch the glands of the stoma lying above it when they grow
When will the pain of leiomyosarcoma be disproportionate?
When there is red degeneration
What do fibroids look like on US?
Smooth exogenic mass, often multiple
What are the 5 locations of fibroids?
Pedunculated Intramural Intracavity Subserous Submucous
What sarcomas commonly display a spindle cell morphology?
Leiomyosarcoma