Endometrial cancer

Question 1

Incidence of endometrial cancer

Answer 1

Incidence rates are increasing.

Question 2

Presentation of endometrial cancer

Answer 2

Over 80% with post menopausal bleeding

Question 3

Most common type of endometrial cancer

Answer 3

Endometriod adenocarcinoma

Question 4

Endometrial adenocarcinoma subtypes

Answer 4

Endometriod (most common)

Serous

Clear cell
- Clear cytoplasm

Mixed (endometriod, serous, clear cell)

Undifferentiated

Carcinosarcoma

Question 5

Endometriod adenocarcinoma

Answer 5

Most common type of endometrial cancer

- Shows differentiation that resembles endometrial glands

Question 6

Serous adenocarcinoma of

Answer 6

Endometrial cancer showing differentiation that resembles fallopian tube epithelium.

Question 7

Type 1 endometrial adenocarcinoma

• Age
• Weight
• Oestrogen
• Endometrial background
• Precursor lesion

Answer 7

50-60s

Obesity is common

Common oestogneic stimulation

Anovulatory

EIN, atypical hyperplasia as precursor lesion.

Question 8

Type 1 endometrial adenocarcinoma

• Transition
• Type
• Molecular genetics
• Familial?
• Prognosis
• Concurrent ovarian cancer?
• Spread

Answer 8

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

Question 9

Type 2 endometrial adenocarcinoma

• Age
• Weight
• Oestrogen
• Endometrial background
• Precursor lesion

Answer 9

Older women- 60-70s

Uncommonly in obese women
- Uncommon oestrogen stimulation

Atrophic endometrium

EIN precursor lesion

Question 10

Type 2 endometrial adenocarcinoma

• Transition
• Type
• Molecular genetics
• Familial?
• Prognosis
• Concurrent ovarian cancer?
• Spread

Answer 10

Unknown transition of tissue

Serous/ mixed adenocarcinoma

Not familial

Uncommonly concurrent with ovarian cancer

Spreads to peritoneum

Poor prognosis

Question 11

4 molecularly organised groups of endometrial cancers

Answer 11

Ultramutated
- Least prevalent (7%)

Hypermutated

Low frequency of DNA copy number alterations

High frequency of DNA copy number alterations

Question 12

Hypermutated endometrial cancer

Answer 12

Second most common of the gneomically classified endometrial cancer
- 28%

Showed defected mismatch repair and microsatelite instability

Question 13

Endometrial cancers that showed low frequency of DNA copy number alterations

Answer 13

Most prevalent mutation in endometrial cancer
- 39%

High frequency = 265

Question 14

Atypical hyperplasia

Answer 14

Precursor region associated with endometrioid adenocarcinoma

Question 15

Endometrial adenocarcinoma epidemiology

• Prevalence
• Lifetime risk
• Commonly affected population
• Peak incidence

Answer 15

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

Question 16

Risk factors for endometrial cancer [7]

Answer 16

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

Question 17

Endogenous hormones and endometrial cancer

Answer 17

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

Question 18

Reproductive factors and endometrial cancer

Answer 18

Pregnancy and parity reduce risk (break from unopposed oestrogen)

Late menopause and early menarche= increased risk.

Question 19

Excess body weight and endometrial cancer

Answer 19

Overweight increases oestrogen levels

• In post-menopausal women
• 34% linked to excess body weight

Central adiposity important

Question 20

DM + insulin and Endometrial cancer

Answer 20

DM = 2x risk of endometrial cancer

Insulin/ IGF may increase oestrogen effects on endometrium

Question 21

Grading of neoplasm

Answer 21

Reflects how of the tumour resembles its parent tissue

Grade 1-3
Well, moderate, poor.

Question 22

Staging of neoplasm

Answer 22

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.

Question 23

Mortality of endometrial cancer

Answer 23

Has been decreasing

- Except for women over 80.