Endometrial Neoplasia Flashcards by Erin Stevenson

What is endometrial hyperplasia?

Overgrowth of the endometrium

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Cause of endometrial hyperplasia

Often unknown, may be due to persistent oestrogen stimulation

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Sub-divisions of endometrial hyperplasia

Simple
Complex
Atypical

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Presentation of endometrial hyperplasia

Abnormal uterine bleeding

Postmenopausal bleeding

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Treatment of endometrial hyperplasia

Premenopausal women: progestogens (e.g. Mirena coil)

Atypical hyperplasia: hysterectomy

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Most endometrial carcinomas are ______

Adenocarcinomas

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Type 1 endometrial carcinomas

Endometrioid, mucinous

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Precursor lesion for type 1 endometrial carcinoma

Atypical endometrial hyperplasia

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Time of presentation of type 1 endometrial carcinoma

Shortly after menopause

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Genetic mutations associated with type 1 endometrial carcinoma

PTEN, KRAS, PIK3CA

Microsatellite instability e.g. Lynch syndrome

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Type 2 endometrial carcinoma

Serous, clear cell

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Precursor lesion for type 2 endometrial carcinoma

Serous endometrial intraepithelial carcinoma

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Which type of endometrial carcinoma is related to unopposed oestrogen?

Type 1

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Which type of endometrial carcinoma higher grade and more aggressive?

Type 2

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Time of presentation of type 2 endometrial carcinoma

Older women

May present with extrauterine disease

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Genetic mutations associated with type 2 endometrial carcinoma

TP53

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Presentation of endometrial carcinoma

Abnormal uterine bleeding
Postmenopausal bleeding
Pain (may indicate metastases)
Pelvic mass (moving in line with the cervix)

Risk factors for endometrial carcinoma

50-60yrs
PCOS
Lynch syndrome
Tamoxifen
T2DM
Obesity

Why is obesity a risk factor for endometrial carcinoma?

Adipocytes express aromatase that converts ovarian androgens into oestrogens which induce endometrial proliferation

Investigations for endometrial carcinoma

TVUS
Endometrial biopsy
Dilatation and curettage
Hysteroscopy
MRI: assess myometrial invasion
CT: distant metastases

Investigations for endometrial hyperplasia

TVUS

Endometrial biopsy

Treatment of endometrial carcinoma

Total hysterectomy with bilateral salpingo-oophorectomy +/- lymphadenectomy

Radiotherapy: adjuvant to prevent recurrence

Treatment for widespread disease in endometrial carcinoma

Chemotherapy

Treatment for patients with endometrial carcinoma who aren’t suitable for surgery

Radiotherapy or high dose progestogens

Treatment for recurrence of endometrial carcinoma

Radiotherapy if not previously received | Progestogens and chemotherapy

Where dose endometrial stromal sarcoma arise from?

Endometrial stroma

What may the initial presentation of endometrial stromal sarcoma be?

Metastases (lung, ovary)

Where dose carcinosarcoma arise from?

Mixed tumour with malignant epithelial and stromal elements

In carcinosarcoma presence of ______ component = worst prognosis

Rhabdomyosarcomatous

Grade 1 endometrial carcinoma

≤5% solid growth

Grade 2 endometrial carcinoma

6-50% solid growth

Grade 3 endometrial carcinoma

>50% solid growth

Stage 1A endometrial carcinoma

Tumour confined to the uterus, no or <1/2 myometrial invasion

Stage 1B endometrial carcinoma

Tumour confined to the uterus, >1/2 myometrial invasion

Stage 2 endometrial carcinoma

Cervical stromal invasion, but not beyond uterus

Stage 3A endometrial carcinoma

Tumour invades serosa or adnexa

Stage 3B endometrial carcinoma

Vaginal and/or parametrial involvement

Stage 3C1 endometrial carcinoma

Pelvic node involvement

Stage 3C2 endometrial carcinoma

Para-aortic involvement

Stage 4A endometrial

Tumour invasion bladder and/or bowel mucosa

Stage 4B endometrial

Distant metastases including abdominal metastases and/or inguinal lymph nodes