Endometrial tumours

Question 1

Endometrial cancer is most common in pre-menopausal women. True or false?

Answer 1

False

- post menopausal women

Question 2

Endometrial cancer typically infiltrates ______

Answer 2

Myometrium

Question 3

Peak incidence occurs in which age group?

Answer 3

50-60 year olds

Question 4

What are the 2 types of endometrial cancer?

Answer 4

Endometrioid carcinoma

Serous carcinoma

Question 5

What is the main risk factor for endometrial cancer?

Answer 5

Obesity

Question 6

Sex hormone binding globulin levels are HIGHER/LOWER in obese women?

Answer 6

Lower

Question 7

Why is obesity a risk factor for endometrial cancer?

Answer 7

Adipocytes express aromatase.
Aromatase converts ovarian androgens -> oestrogens.
Increased level of oestrogen induces endometrial proliferation.

Question 8

Which condition is associated with endometrial cancer?

Answer 8

Lynch syndrome

Question 9

Endometrial cancer - clinical features

Answer 9

Abnormal bleeding

- post menopausal bleeding

Question 10

Endometrial cancer - investigations

Answer 10

Transvaginal US 
- assess thickness of endometrium 
MRI scan 
- assess degree of myometrial invasion 
CT scan 
- looks for distal nodal mets

Question 11

Endometrial cancer - how many stages are there

Answer 11

4

Question 12

Endometrial cancer - stage I

Answer 12

Confined to uterus
Ia - less than 50% myometrial invasion
Ib - over 50% myometrial invasion

Question 13

Endometrial cancer - stage II

Answer 13

Tumour invades cervical stroma

Question 14

Endometrial cancer - stage III

Answer 14

Local and/or regional tumour spread

Question 15

Endometrial cancer - stage IV

Answer 15

Tumour invades bladder and/or bowel mucosa and/or distant metastases

Question 16

Endometrial cancer - management if the tumour has not invaded?

Answer 16

Hysterectomy

Question 17

Endometrial cancer - management options

Answer 17

Surgery - hysterectomy
Radiotherapy
Chemotherapy

Question 18

Type 1 tumours

Answer 18

Endometrioid (and mutinous) carcinoma

Question 19

Type 2 tumours

Answer 19

Serous (and clear cell) carcinoma

Question 20

Which is most common: Endometrioid (and mucinous) carcinoma OR Serous (and clear cell) carcinoma

Answer 20

Endometrioid (and mucinous) carcinoma

Question 21

Which is most aggressive: Endometrioid (and mucinous) carcinoma OR Serous (and clear cell) carcinoma

Answer 21

Serous (and clear cell) carcinoma

Question 22

Which type of cancer is relate to unopposed oestrogen? Endometrioid (and mucinous) carcinoma OR Serous (and clear cell) carcinoma

Answer 22

Endometrioid (and mucinous) carcinoma

Question 23

What is the precursor for endometrioid (and mucinous) carcinoma?

Answer 23

Complex atypical hyperplasia

Question 24

Endometrioid (and mucinous) carcinoma - what are the 3 mutations?

Answer 24

PTEN
KRAS
PIK3CA

Question 25

Endometrioid (and mucinous) carcinoma is associated with which syndrome?

Answer 25

Lynch syndrome

Question 26

Endometrioid (and mucinous) carcinoma spreads early and most present with extrauterine disease. True or false?

Answer 26

False | - usually confined to the uterus at presentation

Question 27

How are Endometrioid (and mucinous) carcinomas graded?

Answer 27

By their solidity Grade 1 - 5% of less solid growth Grade 2 - 6-50% solid growth Grade 3 - over 50% solid growth

Question 28

Serous (and clear cell) carcinoma is associated with unopposed oestrogen. True or false?

Answer 28

False

Question 29

What is the precursor for Serous (and clear cell) carcinoma ?

Answer 29

Serous endometrial intraepithelial carcinoma

Question 30

Serous (and clear cell) carcinoma - mutation

Answer 30

P53 over-expression

Question 31

Serous (and clear cell) carcinoma spreads early and most patients present with extrauterine disease. True or false?

Answer 31

True

Question 32

Serous (and clear cell) carcinoma - grading

Answer 32

Not routinely graded as they are so aggressive

Question 33

Carcinosarcoma - definition

Answer 33

Mixed tumour of both gland and storm together

Question 34

High/low levels of oestrogen are said to increase the risk of developing an endometrial malignancy>

Answer 34

High

Question 35

The incidence of endometrial cancer is higher/lower in women who take the OCP

Answer 35

Lower

Question 36

Name 5 factors which may cause increased oestrogen in the body?

Answer 36

``` Obesity PCOS Nulliparity Late menopause Unopposed ostrogen HRT ```

Question 37

WHat is the principle symptom of endometrial malignancy?

Answer 37

Post menopausal bleeding

Question 38

First line investigation for a woman presenting with post menopausal bleeding

Answer 38

TVUSS | - can measure endometrial thickness

Question 39

Name a diagnostic investigation for endometrial cancer?

Answer 39

Hysteroscopy + dilation / curetage

Question 40

What is the treatment of endometrial HYPERPLASIA in young women

Answer 40

Progestogens medication - eg POP | Mirena IUD - delivers progesterone to the endometrium

Question 41

Cervical stromal invasion (but not beyond uterus) would have which figo stage?

Answer 41

II

Question 42

TUmour invasion into bladder and/or bowel would have what stage?

Answer 42

IV(a)

Question 43

Tumour invasion into serosa or adenexa would have which stage?

Answer 43

III(a)

Question 44

Pelvic / para-aortic lymph node involvement would have which stage?

Answer 44

III(c)

Question 45

What is mainstay of treatment

Answer 45

Hysterectomy +/- bilateral salpingo-oophrectomy

Question 46

What is the most common site of recurrence for endometrial cancer?

Answer 46

Vault of vagina