Endometrial carcinoma Flashcards
what types of endometrial carcinomas are there?
Type 1 and Type 2
what are examples of type 1 endometrial tumours?
-Mucinous carcinoma
-Endometrioid carcinoma
what is the precursor for type 1 endometrial carcinomas?
type 1 endometrial carcinomas= mucinous and endometrioid carcinomas
precursor= atypical hyperplasia
what hormone is atypical hyperplasia of the endometrium related to?
endometrial atypical hyperplasia is related to unopposed oestrogen
what mutations are associated with type 1 endometrial carcinoma?
type 1 endometrial carcinoma= mucinous and endometrioid carcinoma
Mutations associated with type 1 endometrial carcinoma:
-PTEN
-KRAS
-PIK3CA
are type 1 or type 2 endometrial carcinomas more common?
type 1 endometrial carcinomas (80%) are more common than type 2 endometrial carcinomas (20%)
examples of type 2 endometrial carcinomas?
type 2 endometrial carcinomas:
-Serous carcinoma
-Clear cell carcinoma
are type 1 or type 2 endometrial carcinomas more aggressive?
type 2 are more agressive (serous and clear cell carcinomas)
precursor for type 2 endometrial carcinomas?
(type 2= serous and clear cell carcinomas)
Precursor for type 2 endometrial carcinoma:
-serous intreaepithelial carcinoma
who is more likely to get a type 2 endometrial carcinoma?
type 2 endometrial carcinoma= serous and clear cell carcinoma
more common in:
-elderly and post menopausal
-TP53 mutation
what mutation is associated with type 2 endometrial carcinoma?
type 2 endometrial carcinoma= serous and clear cell carcinoma
mutation= TP53
how does type 2 endometrial carcinoma spread?
spreads along fallopian tube mucosa and peritoneal surfaces and so can present with extrauterine disease
what type of cancer has:
‘Complex papillary and/or glandular architecture with diffuse, marked nuclear polymorphism’
Serous carcinoma (type 2 endometrial cancer)
first line investigation for endometrial carcinoma?
transvaginal USS to measure endometrial thickness
in post menopausal normal <4mm
what is a normal endometrial thickness of a post menopausal woman?
<4mm
what is stage 1 endometrial carcinoma? (FIGO staging)
Stage 1= confined to uterus
1A no or <50% myometrium invaded
1B 50% or >50% of myometrium invaded
what is stage 2 endometrial carcinoma? (FIGO staging)
Stage 2= cancer invades cervix
what is stage 3 endometrial carcinoma? (FIGO staging)
Stage 3= cancer invades ovaries, fallopian tubes, vagina or lymph nodes
what lymph nodes do endometrial carcinomas tend to invade?
para- aortic lymph nodes
what is stage 4 endometrial carcinoma (FIGO staging)
stage 4= invasion of bladder, rectum or beyond pelvis
Treatment for stage 1 endometrial carcinoma?
treatment for stage 1 + 2 endometrial cancer is the same
-total abdominal hysterectomy with bilateral salpingooophorectomy
Treatment for stage 2 endometrial cancer?
treatment for stage 1 + 2 endometrial cancer is the same
-total abdominal hysterectomy with bilateral salpingooophorectomy
Treatment for stage 3 endometrial cancer?
maximal debulking surgery + radiotherapy + chemotherapy
treatment for stage 4 endometrial cancer?
maximal debulking surgery + palliative approach (low dose radiotherapy)
how are type 2 endometrial carcinomas typically graded and treated?
Type 2 are more aggrressive and so are immediately high graded
treatment= extensive surgery + chemo/radiotherapy
what can be used to shrink endometrial carcinomas in patients who cant have surgery?
-high dose oral progesterones
-radiotherapy
is radiotherapy or surgery more effective ?
surgery is more affective in most gynaecological cancers
what should be considered in a young woman with endometrial carcinoma?
consider underlying predisposition:
-Lynch syndrome
-PCOS
risk factors for endometrial carcinoma?
-Obesity
50-60 years
-Post menopausal women
-Nullparity
-Prolonged period of anovultation e.g. early menarche/ late menopause, low parity, PCOS
young women with endometrial carcinoma, think PCOS or Lynch syndrome
how do endometrial carcinomas spread?
-Directly into myometrium and cervix
-Lymphatic
-Haematogenous
presentation of endometrial carcinoma?
Abnormal bleeding
* Most commonly postmenopausal bleeding
* Post coital bleeding
* Intermenstrual bleeding
Abnormal vaginal discharge
Haematuria
inheritance of Lynch syndrome (HNPCC) ?
autosomal dominant
what cancers are you most likely to inherit from Lynch syndrome (HNPCC)?
Colerectal cancer (most common)
Endometrial cancer
Ovarian cancer
Pancreatic cancer
what are protective factors of endometrial carcinoma?
multiparity
combined oral contraceptive pill
smoking (the reasons for this are unclear)
prognosis for endometrial carcinoma?
good prognosis
for stage 1 there is a 85-90% survival rate
treatment for post menopausal women with atypical endometrial hyperplasia
total hysterectomy and bilateral salpingo-oophrectomy
treatment for women with atypical endometrial hyperplasia?
total hysterectomy
