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Year 2 Medicine > Pathology of the Female Reproductive Tract 3 > Flashcards

Pathology of the Female Reproductive Tract 3 Flashcards

1
Q

Age standardised incidence rates of endometrial cancer (UK 1993-2016)

A
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2
Q

The predominant endometrial cancer arises in the … of the ….

A

The predominant endometrial cancer arises in the glands of the endometrium

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3
Q

Malignant neoplasm of glandular epithelium = …

A

Malignant neoplasm of glandular epithelium = adenocarcinoma

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4
Q

Over …% of women with endometrial cancer present with post menopausal bleeding

A

Over 80% of women with endometrial cancer present with post menopausal bleeding

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5
Q

Endometrium

  • Composed of glands in a specialised … with a specialised blood supply
  • Growth, maturation and regression of all three components is co-ordinated during each … cycle
A
  • Composed of glands in a specialised stroma with a specialised blood supply
  • Growth, maturation and regression of all three components is co-ordinated during each menstrual cycle
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6
Q

… vs … (endometrium)

A

normal endometrium vs adenocarcinoma

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7
Q

What is shown here?

A

Uterus opened - can see a tumour on endometrium

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8
Q

Adenocarcinomas

  • Adenocarcinomas arising at different sites in the body have different … factors, pathogenesis, appearances, … abnormalities, b…, p… and t….
  • Among adenocarcinomas arising at a single site there are multiple …, initially divided by different appearances and increasingly supplemented by understanding molecular genetic pathogenesis.
A
  • Adenocarcinomas arising at different sites in the body have different risk factors, pathogenesis, appearances, genetic abnormalities, behaviour, prognosis and treatment.
  • Among adenocarcinomas arising at a single site there are multiple subtypes, initially divided by different appearances and increasingly supplemented by understanding molecular genetic pathogenesis.
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9
Q

Subtypes of endometrial adenocarcinoma by morphology (microscopic appearance)

  • Endo…
  • S…
  • … cell
  • … (components of the previous 3)
  • Un… / De…
  • Carcino…
A
  • Endometrioid
  • Serous
  • Clear cell
  • Mixed (components of the previous 3)
  • Undifferentiated / Dedifferentiated
  • Carcinosarcomas
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10
Q

Endometrioid Adenocarcinoma

  • Endometrioid cancers show differentiation that resembles … …
A

Endometrioid cancers show differentiation that resembles endometrial glands

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11
Q

Serous cancers were thought to resemble .. … epithelium

A

Serous cancers were thought to resemble Fallopian tube epithelium

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12
Q

Clear cell cancers have clear …

A

Clear cell cancers have clear cytoplasm

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13
Q

Adenocarcinoma Subtypes

  • Adenocarcinoma subtypes with similar appearance and the same names occur at other sites
    • eg there is a clear cell carcinoma of the ovary
  • They are NOT the … …
  • If a tumour has spread to other sites it can be very difficult to work out which is the site of … and which is the site of …
A
  • Adenocarcinoma subtypes with similar appearance and the same names occur at other sites
    • eg there is a clear cell carcinoma of the ovary
  • They are NOT the same disease
  • If a tumour has spread to other sites it can be very difficult to work out which is the site of origin and which is the site of metastasis
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14
Q

Demographic and histologic studies suggest two groups of women with endometrial adenocarcinoma

  • These 2 groups differ with respect to:
    • C..
    • A..
    • M… types of …
    • M… … …
    • P… L…
    • P and T
A
  • These 2 groups differ with respect to:
    • Cause
    • Age
    • Morphologic types of tumour
    • Molecular genetic abnormalities
    • Precursor lesions
    • Prognosis and Treatment
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15
Q

Endometrial Adenocarcinoma - Type 1 and Type 2

A
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16
Q

Molecular Pathology - Endometrial Cancer

A
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17
Q

The cancer genome atlas (TCGA) published an integrated genomic classification of endometrial cancer in … groups

A
  • The cancer genome atlas (TCGA) published an integrated genomic classification of endometrial cancer in 4 groups
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18
Q

TCGA Endometrial Cancers

  • 4 groups…__​
    • … cancers (DNA pol epsilon mutations) 7%
    • … cancers (defective mismatch repair and microsatelite instability) 28%
    • Endometrial cancers with … frequency of DNA copy number alterations 39%
    • Endometrial cancers with … frequency of DNA copy number alterations 26%
A
  • Ultramutated cancers (DNA pol epsilon mutations) 7%
  • Hypermutated cancers (defective mismatch repair and microsatelite instability) 28%
  • Endometrial cancers with low frequency of DNA copy number alterations 39%
  • Endometrial cancers with high frequency of DNA copy number alterations 26%
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19
Q

Precursor lesions - Cervix

  • In the cervix, the precursor lesion to invasive squamous cell carcinoma is
    • … … …(CIN)
  • The disease process is called …
  • We detect CIN by
    • screening for HR … infection,
    • looking for … cells,
    • examining the cervix by …
    • … eg by LLETZ
A
  • In the cervix, the precursor lesion to invasive squamous cell carcinoma is
    • Cervical Intra-Epithelial Neoplasia (CIN)
  • The disease process is called dysplasia
  • We detect CIN by
    • screening for HR HPV infection,
    • looking for abnormal cells,
    • examining the cervix by colposcopy
    • Treating eg by LLETZ
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20
Q

We know much less about precursor lesions in the endometrium (compared to cervix - CIN)

  • It is assumed that the common (endometrioid) form of endometrial carcinoma has its origin in a lesion called … …
  • This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma
A
  • It is assumed that the common (endometrioid) form of endometrial carcinoma has its origin in a lesion called atypical hyperplasia
  • This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma
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21
Q

The woman at risk of endometrial adenocarcinoma

  • … common … cancer of the female genital tract in UK
  • … most common cancer in women in the UK (breast, lung, colorectum)
  • Lifetime risk of 1 in …
  • Usually arises in … women
  • Peak incidence in the ..-.. y/o age group
  • Most common presenting feature is … bleeding (c80%)
A
  • Most common invasive cancer of the female genital tract in UK
  • Fourth most common cancer in women in the UK (breast, lung, colorectum)
  • Lifetime risk of 1 in 46
  • Usually arises in postmenopausal women
  • Peak incidence in the 55-65 y/o age group
  • Most common presenting feature is postmenopausal bleeding (c80%)
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22
Q

What is shown here? (endometrium??)

A

Atypical Hyperplasia - precursor lesion in endometrium

23
Q

Lifetime risk of 1 in … (Endometrial adenocarcinoma)

A

Lifetime risk of 1 in 46 (Endometrial adenocarcinoma)

24
Q

The most common presenting feature of endometrial adenocarcimoma is

A

postmenopausal bleeding (80%)

25
Q

Endometrial adenocarcinoma is the … most common cancer in woman in the UK

A

fourth (after breast, lung, colorectum)

26
Q

What is the most common invasive cancer of the female genital tract in UK?

A

Endometrial adenocarcinoma

27
Q

Peak incidence of endometrial adenocarcinoma is … (Age group?)

A

55-65 yo

28
Q

Endometrial carcinoma by age

  • Peak in …
A
  • Peak in postmenopausal women
29
Q

Risk factors for endometrial cancer

  • … hormones and … factors
  • Excess … …
  • … … and insulin
  • … hormones & modulators
  • E…
  • F.. (Cowden’s syndrome; HNPCC)
  • … not a risk
A
  • Endogenous hormones and reproductive factors
  • Excess body weight
  • Diabetes mellitus and insulin
  • Exogenous hormones & modulators
  • Ethnicity
  • Familial (Cowden’s syndrome; HNPCC)
  • Smoking not a risk
30
Q

Is smoking a risk factor for endometrial cancer?

A

No

31
Q

Endogenous hormones

  • Excess exposure to estrogen unopposed by progestogens
  • Overweight increases estrogen levels in … women
  • Overweight can disrupt ovulation and progestogen production in … women
  • … ovarian disease
  • Some rare … … can produce estrogens
A
  • Excess exposure to estrogen unopposed by progestogens
  • Overweight increases estrogen levels in post menopausal women
  • Overweight can disrupt ovulation and progestogen production in pre menopausal women
  • Polycystic ovarian disease
  • Some rare ovarian neoplasms can produce estrogens
32
Q

Reproduction & Endometrial Cancer

  • Pregnancy and parity … the risk of endometrial cancer
    • Mechanism includes the … from unopposed … during pregnancy and the removal of … cells at delivery
  • Early menarche and late menopause … risk (… by 7% for each year fewer)
A
  • Pregnancy and parity reduce the risk of endometrial cancer
  • Mechanism includes the break from unopposed oestrogen during pregnancy and the removal of abnormal cells at delivery
  • Early menarche and late menopause increase risk (reduced by 7% for each year fewer)
33
Q

Excess body weight & Endometrial Cancer

  • c … % endometrial cancers are linked to excess body weight
  • … - … times increased risk in overweight women
  • Increased risk begins with a … elevated BMI
  • Central … (waist circumference and waist:hip ratios) may be more important than …
A
  • c 34 % endometrial cancers are linked to excess body weight
  • 2-3 times increased risk in overweight women
  • Increased risk begins with a moderately elevated BMI
  • Central adiposity (waist circumference and waist:hip ratios) may be more important than BMI
34
Q

Diabetes mellitus and insulin & Endometrial Cancer

  • Women with diabetes mellitus have a …-fold increased risk of endometrial cancer
  • Hard to separate effect of insulin from excess body weight but a probably direct effect
  • Insulin and insulin-like growth factors may increase the effects of … on the endometrium
A
  • Women with diabetes mellitus have a two-fold increased risk of endometrial cancer
  • Hard to separate effect of insulin from excess body weight but a probably direct effect
  • Insulin and insulin-like growth factors may increase the effects of estrogen on the endometrium
35
Q

Exogenous hormones & modulators - Endometrial Cancer

  • Hormone replacement therapy
    • Unopposed estrogen (RR is …)
  • Tamoxifen (RR is ..)
A
  • Hormone replacement therapy
    • Unopposed estrogen (RR 6.0)
  • Tamoxifen (RR 2.0)
36
Q

Ethnicity & Endometrial Cancer

  • US studies show endometrial carcinoma is … common in African American women
    • 13 per 105 in African-American women
    • 23 per 105 in white
  • BUT this group has higher mortality (x…)
  • Many variables involved
    • Later stage at D…
    • U… tumour type
    • S… factors and treatment
    • Co…
A
  • US studies show endometrial carcinoma is less common in African American women
    • 13 per 105 in African-American women
    • 23 per 105 in white
  • BUT this group has higher mortality (x4)
  • Many variables involved
    • Later stage at diagnosis
    • Unfavourable tumour type
    • Sociodemographic factors and treatment
    • Comorbidities
37
Q

Evaluation of parameters informing behaviour and treatment - Endometrial Cancer

  • There are three tumour-specific parameters
    • Tumour …
    • Tumour …
    • Tumour …
A
  • There are three tumour-specific parameters
    • Tumour type ✔
    • Tumour grade
    • Tumour stage
38
Q

Grading of Neoplasms

  • Grading reflects how much a tumour … its … tissue
  • Has to be done on tissue under a …
  • Many use a three-point system
    • … differentiated Grade 1
    • … differentiated Grade 2
    • … differentiated Grade 3
A
  • Grading reflects how much a tumour resembles its parent tissue
  • Has to be done on tissue under a microscope
  • Many use a three-point system
    • Well differentiated Grade 1
    • Moderately differentiated Grade 2
    • Poorly differentiated Grade 3
39
Q

Grading of endometrial carcinoma

  • Normal endometrial epithelium matures to form glands
  • … also form glands
  • The fraction of the tumour forming glands is estimated as a percentage
    • (then divided into three groups)
  • Tumour grade affects …
A
  • Normal endometrial epithelium matures to form glands
  • Adenocarcinomas also form glands
  • The fraction of the tumour forming glands is estimated as a percentage
    • (then divided into three groups)
  • Tumour grade affects prognosis
40
Q

Staging systems

  • For all neoplasms a T N M system exists
    • T for …: … spread
    • N for …: … … deposits
    • M for …: … deposits
  • For gynaecological tumours a different system called … is usually used
A
  • For all neoplasms a T N M system exists
    • T for tumour: local spread
    • N for nodes: lymph node deposits
    • M for metastasis: metastatic deposits
  • For gynaecological tumours a different system called FIGO is usually used
41
Q

What staging system is usually used for gynaecological tumours?

A

FIGO (not usually TNM system)

42
Q

FIGO Staging of Endometrial Carcinoma

  • Stage 1: Confined to …
  • Stage 2: Involving …
  • Stage 3: S…/A…/V…/… …
  • Stage 4: B.., B…, Distant …
A
  • Stage 1: Confined to corpus
  • Stage 2: Involving cervix
  • Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
  • Stage 4: Bladder, Bowel, Distant Metastasis
43
Q

Most ‘endometrial cancers’ arise from endometrial … and are …

A

Most ‘endometrial cancers’ arise from endometrial glands and are adenocarcinomas

44
Q

There are several different types of adenocarcinoma – the most common is called … because it resembles … glands

A

There are several different types of adenocarcinoma – the most common is called endometrioid because it resembles endometrial glands

45
Q

Recognizing different types of adenocarcinoma benefits patients since it informs likely … and …

A

Recognizing different types of adenocarcinoma benefits patients since it informs likely prognosis and treatment

46
Q
  • Other types of endometrial adenocarcinoma can be recognized …
  • These may have distinct molecular … and …
A
  • Other types of endometrial adenocarcinoma can be recognized microscopically
  • These may have distinct molecular abnormalities and behaviour
47
Q

Endometrioid cancer has a precursor lesion called … …

A

Endometrioid cancer has a precursor lesion called atypical hyperplasia

48
Q

Tumour … estimates the degree to which the neoplasm matures and informs prognosis and treatment

A

Tumour grading estimates the degree to which the neoplasm matures and informs prognosis and treatment

49
Q

Tumour … demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment

A

Tumour staging demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment

50
Q

Incidence of endometrial cancer has been increasing in the last ten yearsRisk factors include:

A
  • Endogenous hormones and reproductive factors
  • Excess body weight
  • Diabetes mellitus and insulin
  • Exogenous hormones & modulators
  • Ethnicity
  • Familial (Cowden’s syndrome; HNPCC)
51
Q

Mortality from endometrial cancer has been falling however, except for women over the age of …

A

Mortality from endometrial cancer has been falling however, except for women over the age of 85

52
Q

Neoplasm Grade 1 = … differentiated

A

well differentiated

53
Q

Neoplasm Grade 2 = … differentiated

A

moderately differentiated

54
Q

Neoplasm Grade 3 = … differentiated

A

poorly differentiated

Year 2 Medicine (162 decks)

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