Endometrial cancer Flashcards
Incidence of endometrial cancer
Incidence rates are increasing.
Presentation of endometrial cancer
Over 80% with post menopausal bleeding
Most common type of endometrial cancer
Endometriod adenocarcinoma
Endometrial adenocarcinoma subtypes
Endometriod (most common)
Serous
Clear cell
- Clear cytoplasm
Mixed (endometriod, serous, clear cell)
Undifferentiated
Carcinosarcoma
Endometriod adenocarcinoma
Most common type of endometrial cancer
- Shows differentiation that resembles endometrial glands
Serous adenocarcinoma of
Endometrial cancer showing differentiation that resembles fallopian tube epithelium.
Type 1 endometrial adenocarcinoma
- Age
- Weight
- Oestrogen
- Endometrial background
- Precursor lesion
50-60s
Obesity is common
Common oestogneic stimulation
Anovulatory
EIN, atypical hyperplasia as precursor lesion.
Type 1 endometrial adenocarcinoma
- Transition
- Type
- Molecular genetics
- Familial?
- Prognosis
- Concurrent ovarian cancer?
- Spread
Slow transition
Type- endometrioid endometrial cancer
Genetics
- MSI, PTEN, PAX2 loss
Familial
- HNPCC
Prognosis is better than type 2
Spreads to the lymph nodes
Commonly concurrent with ovarian cancer
Type 2 endometrial adenocarcinoma
- Age
- Weight
- Oestrogen
- Endometrial background
- Precursor lesion
Older women- 60-70s
Uncommonly in obese women
- Uncommon oestrogen stimulation
Atrophic endometrium
EIN precursor lesion
Type 2 endometrial adenocarcinoma
- Transition
- Type
- Molecular genetics
- Familial?
- Prognosis
- Concurrent ovarian cancer?
- Spread
Unknown transition of tissue
Serous/ mixed adenocarcinoma
Not familial
Uncommonly concurrent with ovarian cancer
Spreads to peritoneum
Poor prognosis
4 molecularly organised groups of endometrial cancers
Ultramutated
- Least prevalent (7%)
Hypermutated
Low frequency of DNA copy number alterations
High frequency of DNA copy number alterations
Hypermutated endometrial cancer
Second most common of the gneomically classified endometrial cancer
- 28%
Showed defected mismatch repair and microsatelite instability
Endometrial cancers that showed low frequency of DNA copy number alterations
Most prevalent mutation in endometrial cancer
- 39%
High frequency = 265
Atypical hyperplasia
Precursor region associated with endometrioid adenocarcinoma
Endometrial adenocarcinoma epidemiology
- Prevalence
- Lifetime risk
- Commonly affected population
- Peak incidence
Most common invasive cancer of the female genital tract in the UK
- 4th most common in women
Lifetime risk= 1 in 46
Population
- Post-menopausal
peak incidence- 55-65
Risk factors for endometrial cancer [7]
Endogenous hormones
Excess body weight
DM and hyperinsulinaemia
Exogenous hormones
- HRT, tamoxifen
Ethnicity
- Higher in caucasian, but higher mortality in African american women (4x)
Familial
- HNPCC, Cowden’s syndrome
Reproductive factors
Endogenous hormones and endometrial cancer
Excess unopposed oestrogen increases risk
PCOS sees increased risk
Ovarian neoplasm can secrete oestrogens
Excess body weight disrupts ovulation and progesterone secretion in pre-menopause
Reproductive factors and endometrial cancer
Pregnancy and parity reduce risk (break from unopposed oestrogen)
Late menopause and early menarche= increased risk.
Excess body weight and endometrial cancer
Overweight increases oestrogen levels
- In post-menopausal women
- 34% linked to excess body weight
Central adiposity important
DM + insulin and Endometrial cancer
DM = 2x risk of endometrial cancer
Insulin/ IGF may increase oestrogen effects on endometrium
Grading of neoplasm
Reflects how of the tumour resembles its parent tissue
Grade 1-3
Well, moderate, poor.
Staging of neoplasm
Spread:
T- local spread
N- to lymph nodes
M- metastasis
In gynae FIGO 1- Corpus 2- Cervix 3- Serosa, adnexa, vagina, lymph nodes 4- Bladder, bowel, distant metastasis.
Mortality of endometrial cancer
Has been decreasing
- Except for women over 80.
