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Reproduction Pathology > Pathology of the Uterus > Flashcards

Pathology of the Uterus Flashcards

1
Q

How many women with PMB will have endometrial cancer?

A

8%

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2
Q

PMB stands for….

A

Post menopausal bleeding

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3
Q

Causes of post menopausal bleeding

A 
Endometrial cancer
Hormone replacement therapy (HRT)
Peri-menopausal bleeding
Atrophic vaginitis 
Polyps - cervical/endometrial 
Other cancer - cervix, vulva, bladder, anal
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4
Q

Definition of atrophic vaginitis

A

Thinning, drying and inflammation of the vaginal walls due to your body having less oestrogen

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5
Q

Investigations for Post menopausal bleeding

A
  1. Transvaginal USS
  2. Endometrial biopsy (if endometrial thickness >4mm or irregular contour)
  3. Hysteroscopy
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6
Q

What does a transvaginal USS look at when investigating PMB?

A

Endometrial thickness

Endometrial contour

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7
Q

Normal findings on transvaginal USS in post menopausal women

A

Endometrium should be thin <4mm

Shouldn’t be tissue there

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8
Q

What stage do women usually present with in endometrial cancer?

A

Stage 1

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9
Q

What stage of menstruation/menopause does endometrial cancer present in?

A

Post menopausal women

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10
Q

Risk factors for endometrial cancer

A 
HIGH CIRCULATING OESTROGEN LEVELS
- obesity
- unopposed E2 (oestrogen) therapy/tamoxifen 
- PCOS 
- Early menarche/late menopause 
Hypertension 
DM
Nulliparity
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11
Q

What familial cancer syndrome is related to endometrial cancer?

A

HNPCC/Lynch type II familial cancer syndrome

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12
Q

Pathological name of endometrial cancer

A

Atypical endometrial hyperplasia

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13
Q

Symptoms of endometrial cancer

A

Abnormal vaginal bleeding

  • premenopausal women may have IMB
  • Post menopausal bleeding
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14
Q

What is the most common symptom of endometrial cancer

A

Post menopausal bleeding

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15
Q

MRI staging of endometrial cancer looks at….

A

Depth of myometrial invasion
Cervical involvement
Lymph node involvement

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16
Q

Staging name of endometrial cancer

A

FIGO staging

17
Q

Stages of endometrial cancer

A 
1A - inner half of myometrium 
IB - outer half of myometrium 
2 - invades cervix
3A - serosa/adnexa 
3B - vagina/parametrium 
3C - pelvic or paraaortic nodes
4 - bladder/bowel/intra-abdominal/inguinal nodes
18
Q

Two distinct categories of endometrial cancer

A

Type 1

Type 2

19
Q

Type 1 endometrial cancer features

A

Endometrial adenocarcinoma
By far the commonest
Unopposed oestrogen
Hyperplasia with atypia precursor

20
Q

Unopposed oestrogen meaning

A

The use of oestrogen alone i.e. without progesterone

21
Q

Type 2 endometrial cancer features

A

Two types (uterine serous carcinoma + Clear cell carcinoma)
high grade, more aggressive, worse prognosis
Generally older ladies
Serious intraepithelial carcinoma precursor
Not so much associated with obesity of unopposed oestrogen so different pathways etc

22
Q

Two types of type 2 endometrial cancer

A
  1. Uterine serous carcinoma

2. Clear cell carcinoma

23
Q

Investigations of endometrial cancer

A

Transvaginal USS scan (endometrial thickness and contour)

Histology of the endometrium

24
Q

Treatment of endometrial cancer

A 
Early stage 
- Surgery TAH/BSO/washings
High risk cytology 
- chemotherapy
Advanced stage 
- radiotherapy 
Palliation 
- progesterone
25
Q

When is laparoscopy done in surgery instead of laparotomy?

A

When there is complications e.g. diabetic, obesity

26
Q

TAH stands for…

A

Total abdominal hysterectomy

27
Q

BSO stands for….

A

Bilateral Salpingo-oophrectomy

28
Q

BSO involves ….

A

the removal of tubes and ovaries

29
Q

Washings involves….

A

Peritoneal washings

30
Q

Cure rates for the stages of endometrial cancer

A 
IB = 85%
IIA = 75%
IIB = 60%
IIIB = 30%
IV = 21%
31
Q

Why is the overall cure rate for endometrial cancer good?

A

Tend to present earlier as notice the bleeding

32
Q

The incidence of endometrial cancer is increasing due to …..

A

increasing obesity

33
Q

What drug is a risk factor for endometrial hyperplasia?

A

Tamoxifen

34
Q

Why does endometrial hyperplasia develop?

A

Due to the presence of unopposed oestrogen

35
Q

Management of endometrial hyperplasia

A

Without atypia - high dose progesterones (IUS may be used)

Atypia - hysterectomy usually advised

Reproduction Pathology (28 decks)

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