Pathology of the female reproductive tract part 3 Flashcards
What are some of the key reasons why endometrial cancer has been steadily increasing and is now the most common gynaecological cancer in the UK?
- increasing age
- obesity
- nulliparity (no births) due to lack of renewal of endometrium
There are 2 types of endometrial cancer, what are they?
- type 1 = endometrioid adenocarcinomas linked to estrogen
- type 2 = not linked to excess oestrogen
There are 2 types of endometrial cancer:
- type 1 = endometrioid adenocarcinomas (glandular) linked to estrogen
- type 2 = not linked to excess oestrogen
Which is more common and more severe?
- type 1 is more common = 80-90% of cases
- type 2 is more aggressive with worse prognosis
What is a adenocarcinomas?
- adeno = latin for gland
- carcinoma = latin for epithelial cells
- cancer that develops in the glands that line your organs
Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as which of the following:
1 - atypical hyperplasia
2 - atypical metaplasia
3 - typical hyperplasia
4 - typical metaplasia
1 - atypical hyperplasia
- essentially abnormal hyperplasia
Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as atypical hyperplasia (abnormal hyperplasia) and is driven by the unopposed production of which hormone?
- estrogen
The slide below shows type 1 endometrial cancer. What is the defining feature of this image that confirms type 1 endometrial cancer?
- increased cell number
- atypia (loss of normal glandular (appearance)
- increased nucleus size
- increased nuclear to cytoplasm ratio
Type 2 endometrial cancers are generally those that are not estrogen dependent. What 5 types of cancers can these be?
- serous (smooth tissue membrane of mesothelium lining)
- clear cell
- mucinous
- squamous
- sarcoma (cancer in connective tissue)
Type 2 endometrial cancers are generally those that are not estrogen dependent. They generally occur in which of the following:
1 - hyperplasia endometrium
2 - atrophic endometrium
3 - metaplastic endometrium
4 - dysplastic endometrium
2 - atrophic endometrium
Type 2 endometrial cancers are generally those that are not estrogen dependent. Which genetic mutation drives this type of cancer?
1 - Rb
2 - p53
3 - BCRA
4 - NUS3
2 p53 gene
- tumour suppressing gene doesn’t work so tumour develops
The grading of type 2 endometrial cancers, those generally are not estrogen dependent. They can be staged on a level of 1-3. What is the staging based upon?
1 - how much tissue is affected
2 - where the affected tissue is
3 - how similar tissue is to healthy tissue
3 - how similar tissue is to healthy tissue
- Well differentiated- Grade 1
- Moderately differentiated- Grade 2
- Poorly differentiated- Grade 3
If a patient has been confirmed as having endometrial cancer they will generally be referred to a multidisciplinary clinic. What investigations will they need prior to being referred to a multidisciplinary clinic?
1 - ultrasound, MRI, biopsy, histology scoring
2 - blood test, MRI, biopsy, histology scoring
3 - genetic testing, MRI, biopsy, histology scoring
4 - ultrasound, MRI, genetic testing, histology scoring
1 - ultrasound, MRI, biopsy, histology scoring
What would be the treatment for a patient with endometrial cancer stage 1 grade 1 and stage 2 grade 2?
1 - MRI and monitor
2 - colposcopy
3 - total abdominal hysterectomy and oophprectomy with pelvis examination
4 - hysterectomy
3 - total abdominal hysterectomy and oophprectomy with pelvis examination
- bilateral oophorectomy (removal of ovaries)
- careful pelvic inspection (staging helps identify risk of metastasis)
What risk is of stage 1-3 of endometrial cancer?
1 - low
2 - intermediate
3 - high
4 - severe
2 - intermediate
What would be the treatment for a patient with endometrial cancer stage 1 grade 3?
1 - MRI and monitor
2 - colposcopy
3 - radical hysterectomy and oophprectomy with pelvis examination
4 - radical hysterectomy, oophprectomy, pelvic and para lymph node dissection and radiotherapy
4 - radical hysterectomy, oophprectomy, pelvic and para lymph node dissection and radiotherapy
What are the 3 methods to do for hysterectomy?
1 - laparoscopic
2 - open abdominal
3 - robotics
UTERUS IS REMOVED VAGINALLY THOUGH
Cervical cancer incidence is declining, what are the main reasons for this?
- smear screening roll out
- diagnosis is earlier
The prevalence of human papillomavirus (HPV) has been reducing between 2008 and now. What is the main reason for this?
- vaccination (ideally prior to exposure to HPV)
- targets HPV strains 16 and 18 using Cervarix
- new HPV vaccine Gardasil targets HPV strains 6, 11, 16 and 18 (changed in 2012)
What are the 3 main treatment options for a patient with a confirmed diagnosis of cervical cancer?
- surgery
- chemotherapy
- radiotherapy (local radiation)
What cell type is associated with aprox 80% of all cervical cancers?
- squamous epithelial cells
In staging of cervical cancer (except for very early staging of disease) how is staging of cervical cancer performed?
- cystoscopy (camera into the bladder) as cervical cancer can spread easily
- patient will be anaesthetised
- spread to bladder is important to determine staging and spread
What imaging modality is used to assess the parametrium and the pelvic and para-aortic lymph nodes?
- MRI
What is the 5 year survival rate of someone with cervical caner?
- 60%
- follow up 6 monthly then annually for 5 years following treatment
The 5 year survival rate of someone with cervical caner is 60%. When is recurrence most likely?
- within 3 years
Is cervical cancer common in pregnancy?
- no
