LM 9.1: Endometrial/Uterine Cancers Flashcards
what is the most common gynecologic malignancy in the US?
endometrial cancer
typically in postmenopausal women
majority are diagnosed in early stages due to abnormal bleeding
what are the types of endometrial carcinomas?
type 1 and type 2
type 1 risk factors are related to excess estrogen states –> excess unopposed estrogen leads to overgrowth of endometrium
type 2 isn’t associated with estrogen excess
what are the risk factors for endometrial cancer?
- older age
- living in north america
- higher level of education or income
- white race
- nulliparity
- infertility
- mensrual irregularities
what is Lynch syndrome?
syndrome characterized by germline mutation of one of the mismatch repair genes
increased colon cancer, ovarian cancer, and type 1 endometrial cancer
AD
prophylactic hysterectomy with bilateral salpingo-oophorectomy is recommended when affected women reach 35 to 40 after childbearing is complete
who should get genetic screening for Lynch syndrome?
patients with endometrial or colorectal cancer and tumor evidence of:
1. microsatellite instability or
- DNA mismatch repair protein loss
first-degree relative with endometrial or colorectal cancer who was diagnosed:
1. before age 60 years or
- is at risk for Lynch syndrome based on personal and medical history
what is simple vs complex hyperplasia without atypic?
simple: glandular and stromal cell elements proliferate excessively –> glands are modestly crowded and typically display normal tubular shape or mild gland-shape abnormalities
complex: abnormal proliferation of primarily glandular elements – some specimens show architectural abnormalities such as papillary infolding
what does simple and complex hyperplasia with atypia look like histologically?
simple: glands are only mildly crowded – occasional glands show nuclear atypia characterized by nuclear rounding and visible nucleoli
complex: glands are markedly crowded and some have papillary infoldings – nuclei show variable atypia
what is the cancer risk associated with hyperplasia without atypia?
low chance of progression to cancer
may spontaneously regress without therapy
treatment is typically using synthetic progestins
how do you treat hyperplasia without atypia?
treatment is typically using synthetic progestins which:
- alter enzymatic pathways to convert estradiol into weaker estrogens
- decrease number of estrogen receptors in endometrial glandular cells
- stimulation of progesterone receptors leads to thinning of the endometrium and stromal decidualization
what is hyperplasia with atypia?
aka endometrioid intraepithelial neoplasia
significant numbers of glandular elements
exhibit cytologic atypia and disordered maturation
precursor to endometrial adenocarcinoma
how do you treat hyperplasia with atypia?
hysterectomy
can attempt high-dose progestin therapy for those wishing to preserve fertility and poor surgical candidates
what are endometrial polyps?
focal, accentuated, benign hyperplastic process composed of endometrial glands, fibrous stroma, and surface epithelium
most common presenting symptom is abnormal bleeding
most frequently in perimenopausal or immediately postmenopausal women
malignant transformation occurs in approximately 5%
what are the types of endometrial cancer?
- endometriod adenocarcinoma
2. non-endometrioid adenocarcinoma
what is endometriod adenocarcinoma?
type 1 endometrial cancer
endometrioid adenocarcinomas are composed of neoplastic glands resembling those of the normal endometrium
cells are typically tall columnar with mild to moderate nuclear atypia – they form glands that are abnormally crowded or “back-to-back”
gland cribriforming, confluence and villous structures with disappearance of intervening stroma distinguish well-differentiated endometrioid adenocarcinoma from complex hyperplasia
subtypes: endometrioid, endometrioid with squamous differentiation, villoglandular, secretory endometrioid
this is the most common type (80%)
“estrogen-dependent” risk factors
what is non-endometriod adenocarcinoma?
type 2 endometrial cancer
subtypes: serous, clear cell, mucinous, squamous, transitional cell, menonephric, undifferentiated
high grade with poorer prognosis than type 1 cancer
“estrogen independent” risk factors
occurs spontaneously characteristically in thin, postmenopausal women with an atrophic endometrium rather than hyperplastic