Endometrial Hyperplasia

Question 1

Mechanism of general Endometrial Hyperplasia.

Answer 1

Result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily counteract estrogen’s proliferative effects on this tissue. “Unopposed Estrogen”

Question 2

Name the 4 classifications of endometrial hyperplasia.

Answer 2

1. Simple
2. Complex
3. Simple w/ cellular atypia
4. Complex w/ cellular atypia

Question 3

Which endometrial hyperplasia categories will most likely develop into carcinoma?

Answer 3

The ones with cellular atypia

Question 4

What is the difference between simple and complex endometrial hyperplasia?

Answer 4

Simple: regular gland pattern
Complex: irregular and crowded gland pattern

Question 5

How do most patients with endometrial hyperplasia present?

Answer 5

Irregular Uterine bleeding

Missed or Infrequent menses

Question 6

Best way to diagnose endometrial hyperplasia.

Answer 6

Endometrial Sampling using:

1. Pipette Biopsy or
2. D&C

(pap smear rarely identifies it)

Question 7

Treatment for Endometrial Hyperplasia.

Answer 7

Hormone Replacement (progestins)
and/or D&C

For patients that don’t want any more children: hysterectomy (curative and removes risk of endometrial cancer)

Question 8

Which population is at biggest risk of endometrial hyperplasia and why?

Answer 8

Post-menopausal women. Even after women reach stages of anovulation, androstenedione is still produced in the adrenal cortex and converted to estrogen in peripheral adipose tissue. But there is no corpus luteum and therefore no progesterone to “oppose” the estrogen. This leads to endometrial hyperplasia which is considered pre-cancerous and commonly develops into cancer.

Question 9

Name the drug that increases risk for endometrial cancer and the mechanism.

Answer 9

Tamoxifen
-the drug is used to treat breast cancer by blocking estrogen receptors in the breast. This diverts the estrogen to bind to receptors in the uterus and causes endometrial hyperplasia.

Question 10

How is endometrial cancer diagnosed?

Answer 10

Endometrial biopsy
or
Fractional D&C (a fractional also samples the cervical tissue to help with staging)

Question 11

Name and describe the endometrial cancer staging system.

Answer 11

FIGO

1: limited to uterus
2: extension to cervix
3: pelvic extension
4: mucosa of bladder/bowel or distant metastasis

Question 12

What can decrease the likelihood of survival even in Stage 1 endometrial cancer?

Answer 12

Penetration thru to the myometrium. If the muscle layer is reached the cancer could spread to lymph nodes.

Question 13

What 3 things do you need to know before treating any cancer?

Answer 13

Staging (location, spreading, etc)
Grading (histological differention)
Cell Type (gland, epithelium, clear cell, etc.)

Question 14

What is the treatment for endometrial carcinoma?

Answer 14

Surgery
Radiation
Chemo (only for recurrence)

Question 15

Reason why uterine sarcoma has a poor prognosis.

Answer 15

Hematogenous Spread