T3 L3 Pathology of female reproductive tract Flashcards
What is the endometrium composed of?
Glands in a specialised storm with specialised blood supply
What is an adenocarcinoma?
Malignant neoplasm of glandular epithelium
What are the subtypes of endometrial adenocarcinoma?
Endometrioid Serous Clear cell Mixed Undifferentiated Carcinosarcomas
What does a serous endometrial adenocarcinoma resemble?
Fallopian tube epithelium
How do the 2 types of groups with endometrial adenocarcinoma differ?
Cause Age Morphologic type of tumour Molecular genetic abnormalities Precursor lesions Prognosis and treatment
What is the common age for type 1 endometrial adenocarcinoma?
50-60s
What is the common age for type 2 endometrial adenocarcinoma?
60-70s
What is the spread in type 1 endometrial adenocarcinoma?
Lymph nodes
What is the spread in type 2 endometrial adenocarcinoma?
Peritoneum
What are the 4 groups of endometrial cancer according to TCGA?
Ultramutated cancers
Hypermutated cancers
Endometrial cancers with low freq of DNA copy number alterations
Endometrial cancers with high freq of DNA copy number alterations
What is the precursor lesion in invasive squamous cell carcinoma?
Cervical intra-epithelial neoplasia
What is the lifetime risk of endometrial adenocarcinoma?
1 in 46
What is the peak age group for endometrial adenocarcinoma?
55-65 years old
What is the most common presenting feature of endometrial adenocarcinoma?
80% have postmenopausal bleeding
What are the risk factors for endometrial cancer?
Endogenous hormones and reproductive factors Excess body weight Diabetes mellitus and insulin Exogenous hormones and modulators Ethnicity Familial - Cowden's syndrome, HNPCC
How do endogenous hormones contribute to a risk factor for endometrial adenocarcinoma?
Excess exposure to oestrogen unopposed by progestogens
PCOS
Some rare ovarian neoplasms can produce oestrogen
How does pregnancy contribute as a risk factor for endometrial adenocarcinoma?
Pregnancy and parity reduces risk of endometrial cancer
Mechanism: break from unopposed oestrogen during pregnancy and removal of abnormal cells at delivery
How is excess body weight linked as a risk factor for endometrial adenocarcinoma?
Increased risk begins with moderately elevated BMI
Central adiposity may be more important than BMI (waist circumference, waist : hip ratio)
What percentage of endometrial cancers are linked to excess body weight?
34%
What variables are involved when considering link between ethnicity and endometrial cancer?
Later stage at diagnosis
Unfavourable tumour type
Sociodemographic factors and treatment
Comorbidities
What are the 3 tumour-specific parameters?
Tumour type
Tumour grade
Tumour stage
What does grading of neoplasms represent?
How much a tumour resembles its parent tissue
What is grade 1?
Well differentiated
What is grade 2?
Moderately differentiated
