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Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health > T3 L3 Pathology of the Female Genital Tract Part 3 > Flashcards

T3 L3 Pathology of the Female Genital Tract Part 3 Flashcards

1
Q

What % of women with endometrial cancer present with post menopausal bleeding?

A

80%

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2
Q

What is the endometrium made up of?

A

Composed of glands in a specialised stroma with a specialised blood supply

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3
Q

What happens to the three regions of the endometrium during the menstrual cycle?

A

Growth, maturation and regression of all three components is co-ordinated during each menstrual cycle

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4
Q

Where do most endometrial cancers arise from?

A

The glands of the endometrium

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5
Q

What type of tumours are endometrial cancers?

A

Malignant neoplasm of glandular epithelium = ADENOCARCINOMA

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6
Q

Do all adenocarcinomas have the same characteristics?

A

NO

Adenocarcinomas arising at different sites in the body have different risk factors, pathogenesis, appearances, genetic abnormalities, behaviour, prognosis and treatment

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7
Q

Among adenocarcinomas arising at a single site there are multiple subtypes. How are they initially divided?

A

Divided by different appearances

Increasingly supplemented by understanding molecular genetic pathogenesis

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8
Q

What are the subtypes of endometrial adenocarcinoma by morphology*?

*microscopic appearance

A
  • Endometrioid
  • Serous
  • Clear cell
  • Mixed (components of the previous 3)
  • Undifferentiated
  • Carcinosarcomas
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9
Q

Why is one of the adenocarcinoma subtypes named “endometrioid”?

A

Endometrioid cancers show differentiation that resembles endometrial glands.

This is the MOST COMMON type of endometrial adenocarcinoma

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10
Q

Why is one of the adenocarcinoma subtypes named “serous”?

A

Serous cancers were thought to resemble the fallopian tube epithelium

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11
Q

Why is one of the adenocarcinoma subtypes named “clear cell”?

A

Clear cell cancers have clear cytoplasm

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12
Q

Is a clear cell carcinoma of the ovary the same as a clear cell carcinoma of the endometrium?

A

NO
They are NOT the same disease

NOTE: 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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13
Q

Demographic and histologic studies suggest two groups of women with endometrial adenocarcinoma. How do these two groups differ?

A

The two groups differ with respect to

  • Cause
  • Age
  • Morphologic types of tumour
  • Molecular genetic abnormalities
  • Precursor lesions
  • Prognosis and treatment
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14
Q

What does the TCGA (The Cancer Genome Atlas) show about endometrial cancers?

A
  1. Ultramutated cancers (DNA pol epsilon mutations) 7%
  2. Hypermutated cancers (defective mismatch repair
    and microsatelite instability) 28%
  3. Endometrial cancers with low frequency of DNA copy
    number alterations 39%
  4. Endometrial cancers with high frequency of DNA
    copy number alterations 26%
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15
Q

What is the precursor lesions to invasive squamous cell carcinoma called?

A

CIN (cervical intraepithelial neoplasia)

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16
Q

What is disease process called in which a CIN is produced?

A

Dysplasia

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17
Q

How is a CIN detected so that it can be treated to prevent cervical carcinoma?

A

Excision of the transformation zone (large loop excision of the transformation zone)

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18
Q

What is assumed to be the origin of the common (endometrioid) form of endometrial carcinoma?

A

A lesion called atypical hyperplasia

NOTE:This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma

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19
Q

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

A

Endometrial adenocarcinoma

20
Q

What is the fourth most common cancer in women in the UK (after breast, lung and colorectum)?

A

Endometrial adenocarcinoma

21
Q

What is the lifetime risk of endometrial adenocarcinoma?

A

1 in 46

22
Q

What group of women does endometrial adenocarcinoma normally arise in?

A

Usually arises in postmenopausal women

23
Q

What age group has the peak incidence of endometrial adenocarcinomas?

A

55-65 y/o age group

24
Q

What are the risk factors for endometrial cancer?

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 (but for the more serious cancers it can be a risk factor)
25
Q

What factors can affect endogenous oestrogens thereby increasing the risk of endometrial cancers?

A
  • Excess exposure to oestrogen unopposed by progestagens
  • Overweight increases oestrogen levels in post menopausal women
  • Overweight can disrupt ovulation and progestagen production in pre menopausal women
  • Polycystic ovarian disease
  • Some rare ovarian neoplasms can produce oestrogens
26
Q

What are the effects of pregnancy and parity on the risk of endometrial cancers? How?

A

Reduces the risk of endometrial cancer

Mechanism includes the break from unopposed oestrogen during pregnancy and the removal of abnormal cells at delivery

27
Q

What are the effects of early menarche and late menopause on the risk of endometrial cancers?

A

Increases risk

reduced by 7% for each year fewer

28
Q

What are 34 % of endometrial cancers linked to?

A

Excess body weight

2-3 times increased risk in overweight women

29
Q

When does increased risk of endometrial cancer begin in overweight women?

A

Increased risk begins with a moderately elevated BMI

30
Q

What factor may be more important than BMI when considering its effect on the risk of endometrial cancer?

A

Central adiposity (waist circumference and waist:hip ratios)

31
Q

What is the risk of endometrial cancer in women that have DM (diabetes mellitus)?

A

Women with diabetes mellitus have a two-fold increased risk of endometrial cancer

NOTE: Hard to separate effect of insulin from excess body weight but a probably direct effect

32
Q

What are the effects of insulin and insulin-like growth factors on oestrogen?

A

Insulin and insulin-like growth factors may increase the effects of oestrogen on the endometrium

33
Q

What are the relative risks of unopposed and tamoxifen in endometrial cancer?

A

HRT - Unopposed estrogen (RR 6.0)

Tamoxifen (RR 2.0)

34
Q

What is the effect of ethnicity of endometrial cancer risk?

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

Risk is LOWER in people of African-American origin BUT they have a HIGHER mortality

35
Q

What variables may be contributing to the higher mortality from endometrial cancer amongst African-American women?

A
  • Later stage at diagnosis
  • Unfavourable tumour type
  • Sociodemographic factors and treatment
  • Comorbidities
36
Q

What are the three tumour-specific parameters for classifying tumours

A

Type
Grading
Staging

37
Q

What does the grade of a neoplasm tell us?

A

Reflects how much a tumour resembles its parent tissue

Estimates the degree to which the neoplasm matures

Has to be done on tissue under a microscope

38
Q

What is the three-point system used in grading tumours?

A

Grade 1 = Well differentiated
Grade 2 = Moderately differentiated
Grade 3 = Poorly differentiated

39
Q

Describe how an adenocarcinoma could be graded

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)

40
Q

What does the tumour grade affect?

A

Its prognosis and treatment

41
Q

What system is used in staging neoplasms?

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

42
Q

What system is used in staging gynaecological tumours?

A

FIGO

43
Q

How do endometrial carcinoma spread?

A

Initially malignant glands invade endometrial stroma (as the endometrium has its own stroma)

Then spreads into the myometrium

Down into the cervix

Where it reaches vessels and spreads via lymphatics or veins to nodes or vagina

44
Q

What are the different stages in the staging of endometrial carcinoma?

A

Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis

Tumour staging demonstrates the extent to which a neoplasm has spread

45
Q

How can recognizing different types of adenocarcinoma benefit the patients?

A

It informs likely prognosis and treatment

46
Q

Mortality from endometrial cancer has been falling however, except for women of which age?

A

Over 85

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health (8 decks)

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