Endometrial Hyperplasia Flashcards
endometrial hyperplastic changes are usually assocated with what hormonal problem
unopposed estrogen stimulation
- means not stabilized by progesterone so it keeps growing
how does endometrial hyperplasia present as microscopically
- prolifertaion of glands and stromal
- crowding of glands
- increase mitosis
- prominent nucleoli
what is endomet hyperplasia aka
pre-cancer of the endometrium
another word for cystic
simple
another word for complex
adenomatous
name the 4 different classifications of endomet hyperplasia
- Simple Endometrial Hyperplasia
- Complex Endometrial Hyperplasia
- Simple Endometrial Hyperplasia with atypia
- Complex Endometrial Hyperplasia with atypia
what are the characteristics of Simple Endometrial Hyperplasia
regular glandular pattern
NO CYTOLOGIC ATYPIA
1% will progress to cancer
what are the characteristics of Complex Endometrial Hyperplasia
Irregular glands crowded back to back
NO ATYPIA
3% will progress to cancer
what are the characteristics of Simple Endometrial Hyperplasia with atypia
regular glandular patterns
CYTOLOGIC ATYPIA
8% will progress to cancer
what are the characteristics of Complex Endometrial Hyperplasia with atypia
irregular crowded glands
CYTOLOGIC ATYPIA
29% will progress to cancer
how does a pt with endomet hyperplasia present s/s
irregular uterine bleeding
-infrequent is missed periods is common
what is the etiology of a missed menses
endometrial lining during the menstrual cycle changes from proliferative to secretory endometrium
what do women who are prone to hyperplasia do or dont have
DONT have progesterone to ensure that there is a synchronized menstrual cycle
Which hormone can a girl lack and still have a period
progesterone
endometroisis patients have hormone imbalance, causing what
lining in one area of the uterus to become thicker faster than antoher area
-eventually outgrows blood supply
so what happens d/t the ischemia of the lining
its going to break off and eventually bleed abnormally
- thus different sections of the uterus will have inconsistent endometrial lining thickening
- lack of concerted shedding of lining
what is is called when the wall gets so think with blood it “hangs” off the uterine wall
endometrial polyp
is it healthy shedding of lining if a pt has 1 concerted period every 3 month
Yes
girls on BCP will have lighter, shorter, less crampy periods because
the pills are designed to not allow to have the tissue grow in the first place
if you’re on BCP are you at risk of developing hyperplasia
NOPE
what is the risk factor for endometrial hyperplasia
over 35 years old
how do you diagnose endometrial hyperplasia
endometrial sampling
office visit - endometrial biopsy w/o dilation
outpts surgery - D&C
can a pap smear show hyperplasia
not really
BUT it can show AGUS results
pap smear is usually used for what
cervical problems
- AGUS (abnl glandular cells of undetermined signfi)
- with AGUS need to do endometrial biopsy and endo cervical canal biopsy to see where the cells are coming from
how do you treat endometrial hyperplasia
hormonal
D&C follow by hormonal
hysterectomy
hormonal tx for endometrial hyperplasia
becoming a carcinoma is low, so giving more progestin can REVERSE this
when do you use D&C followed by hormonal for endometrial hyperplasia
if you have lots of or severe form
when do you do a hysterectomy for endometrial hyperplasia
in most severe form (complex with atypia will be treated aggressively) or no longer at birthing age
treatment can be affected by what three things
pts age
maintaining fertility
histiologic type of hyperplasia
what is the 4th most common cancer for woman
endometrial cancer
which age group is does endometrial cancer occur
50-59 year old
75% occur in post-menopausal
-not ovulating anymore
how are women able to make estrogen even after menopause
via the adrenal glands
what mostly occurs in chunkers women and how does it happen
endometrial hyperplasia
-converting androsteindione to estrone (or E3 estriol, i dk) in all that adipose tissues
what happens to post meno skinny bitches
suffer more symptoms of menopause BUT they dont develop endometrial hyperplasia
if a woman is still making estrogen but lack progesterone, what can you do
give them progestrone
-giving cyclic progestin will ensure they have at least one good period every 1-3 months
what does giving depo or low dose bcp allow
continuous progesterone administration
-which will stop the normal hormonal production of pulsatile motion
what are the risk factors of endometrial cancer
Early menarche Late menopause Unopposed estrogen Nulliparity Obesity Diabetes Tamoxifen use Other pelvic cancer
what is the MOST at risk factor
unopposed estrogen
- chronic anovulation
- extra-genital estrogen production
how is Tamoxifen a risk factor
its used for blocking the estrogen receptors in the breast but has OPPOSITE effect on the ovaries/uterus
when is the peak time for women to develop endometrial hyperplsia and carcinoma
40-50’s (perimenopausal)
what are the s/s of endometrial cancer
- abnl uterine bleeding
- pre-menopausal: menorrhagia or metrorrhagia
- post-meno: bleeding of any amt is always anbl and needs to be investigated
how do you diagnose endometrial cancer
> 35 years old with irregular bleeding
- endometrial biopsy
- D&C
how do you stage endometrial cancer
FIGO surgical staging
what is the FIGO staging
Stage 1: limited to UTERUS
Stage 2: extension to CERVIX
Stage 3: PELVIC extension
Stage 4: mucosa of BLADDER/BOWEL or distant metastases
what is menorrhagia
excessive uterine bleeding
what is metrorrhagia
irregular uterine bleeding
what needs to be done for a lymphatic spread to lymph nodes
post-operative radiology
which stage has the best 5 year survival rate of endometrial cancer
stage one 75-90%
the other stage survival rates
Stage two 15% - 60%
Stage three 7% - 35%
Stage four 3% - 10%
what is the most COMMON spread patteren
direct extension to adjacent tissues
in cases with deep myometrial invasion, where is teh lymphatic spread usually
pelvic and para-aortic nodes
which spread is less likely
hematogenous spread
what is the most common histologic type
adenocarcinoma - 60%
other histological types
Adenocanthoma- 22% Clear cell- 6% Papillary serous- 5% Secretory- 1.5% Adenosquamous carcinoma- 7%
why is staging needed
to tell us where it is, where it started, where it spread
prognosis : staging of tumor
Myometrium invasion
Peritoneal cytology
Lymph nodes
Adnexal involvement
what does grading of tumor mean
nuclear atypia of the tissue involved in the cancer
- Grade 1 – well differentiated carcinoma
- Grade 2 – moderately well differentiated
- Grade 3 – undifferentiated, or poorly differentiated
histiologic differentiation
how do you treat endometrial cancer
surgery
radiation
chemotherapy
what 2 types of radiation can be done
- external beam
- intra-cavitary*
- done before hysterectomy
- treating and closing down any lymph spread before hysterectomy
is chemo used regularly
no
-usually reserved for recurrence (rescue therapy)
which down there cancer is much more aggressive than endometrial carcinoma
uterine sarcoma (muscle –> myometrium)
uterine sarcoma prognosis
POOR! stage 1 has 50% 5 yr survival rate
