Endometrial carcinoma, cysts and ovarian cancer Flashcards
endometrial carcinoma - peak incidence?
60
uncommon under?
40
in young women with endow carcinoma, consider? (2)
POS or lynch syndrome
most endometrial carcinomas are?
adenocarcinomas
2 main types?
endometroid (and mucinous), serous (and clear cell)
which is the most common ?
endometroid (80%)
precursor for endometroid?
atypical hyperplasia
precursor serous?
serous epithelial intraepithelial carcinoma (isis)
how do endometrial cancers usually present?
abnormal bleeding
how do they spread (ah dunno)
haematogenous, lymphatic, direct spread
type 1 tumours - related to?
unopposed oestrogen
what gene often mutated in type 2?
TP53 - these tumours are not related to unopposed oestrogen
which type of tumour more seen in elderly, post menopausal women?
serous
PTEN, KRAS and PIK3A mutations associated with?
type 1
microsatellite instability?
type 1
describe how obesity is a risk factor for endometrial carcinoma?
fat cells express aromatase. converts androgens into oestrogen (oestrione) e1. causes endometrial proliferation. sex hormone binding globulin lower in obese women, so there are higher levels of free unbounded hormone. also less insulin binding globulin. Insulin and IGF exert proliferative effect on endometrium
cancer pre disposition syndrome, high risk of colorectal cancer and endometrial cancer?
lynch
how is it diagnosed?
immunochemistry staining of the tumour for mismatch repair proteins can help identify tumours due to lynch syndrome
which are more aggressive? endometroid or s?
s, they need more extensive surgery and adjuvant chemo/radiotherapy used more frequentlty
serous carcinomas are characterised by a complex papillary and/or glandular architecture with diffuse, marked nuclear pleomophism
endometrial carcinoma typically infiltrates myometrium, while serous spreads earlier to peritoneal cavity
treatment of endometrial cancer?
hystorectomy/radiotherapy
staging of endometrial cancer 1-?
- with 4 being invading bladder/bowel/disant mets
carcinosarcome - what grade?
high grade, usually poor outcome
fibroids associated with?
menorrhagia, infertility, most common cause of pelvic mass, pressure symptoms, tenderness
what is a fibroid?
smooth muscle tumour
leiomyosarcoma - bulky uterus, heavy bleeding, infertility, what kind of morphology?
spindle cell
differentiate benign from malignant?
malignant causes vaginal bleeding. has poor prognosis
commonest cause of uterine mass?
fibroma
when do you get polyps?
perimenopause
who gets fibroids?
very common in over 40s
how do you diagnose them?
ultrasound
buzzword?
smooth echogenic mass, often multiple
management?
watch and wait - hysterectomy if family complete
sausage shape uterine tube?
hydrosalpinx - distally blocked
fallopian tube filled/distended with pus?
pyosalpinx
paratubal cyst?
usually small and incidental
functional cysts - rarely over 5 cm, when wold they cause pain?
if they bleed or rupture
what can cause blood filled cysts in the ovaries?
endometriosis
pre menstrual pain, painful sex, severe painful menstruation?
endometriosis blood filled cysts
why would sex cause pain cysts
moves and twists them
TENDER MASS WITH NODULARITY AND TENDERNESS BEHIND UTERUS
endometriosis, blood filled cysts
what type of cysts rupture?
chocolate cysts
5 surface epithelium ovarian tumours?
serous, mucinous, enometriod, clear cell, brenner
why can you not pick up a teratoma with US?
doesn’t pick up fat
remember if its a stomal cell tumour, it can secrete oestrogen (granuloma), theca leydic can secrete androgens.
y
what is meigs syndrome?
ascites, pleural effusion, benign ovarian tumour
where are the most common sites for cancer spread to ovary?
breasts, stomach, pancreas
why do you get ascites in ov cancer?
cancer cells irritate lining of peritoneum and cause fluid to build up
nullparity is a rsk factor, why?
having a child is a rest period for ovaries
imaging - what is better to image nature of the cyst?
US
what would you use to look for mets?
CT
CA125 - raisd in what percentage of oc?
80
does a normal level exclude cancer?
no
treatment of ovarian cancer?
removal of ovaries and uterus and inspection of all peritoneal surfaces
cure likely?
no, unless confined to ovary at time of presentation
ascites*** common complication
would do a bimanual examination
what is low albumin relevant for in ovarian cancer?
albumin is a prognostic indicator
for suspected ovarian cancer, what imaging technique would you use?
CT, if suspect ovarian cancer, open surgery
why do follicular cysts form
when ovulation doesn’t occur. i.e. follicle doesn’t rupture, grows until it becomes a cyst
how long do they take to resolve?
a few months
pain, cyst formation, ectopic pregnancy, adhesions, infertilit, malignancy?
endometriosis
serous, mucinous, endometroid, clear cell, brenner, undifferentiated - what are they?
epithelial cell tumours of ovary
serous carcinoma - 2 types?
high grade and low grade
endometroid and clear cell - strong association with? 2 things
endometriosis and lynch syndrome
usually a benign tumour, malignant variants are rare?
brenner
germ cell tumour (teratoma) rarely becomes malignant
sex cell stream tumours - FGS fibroma, granolas, sertoli
4 places you get spread of cancer to the ovary?
stomach, breast, colon, pancreas
inflammation of the fallopian tubes?
salpingitis
