T3 L3:Pathology of the Female Reproductive Tract Flashcards
describe the body of the uterus
Look at slide 4 -(how was it )
what is a prevalent symptom of endometrial cancer in post-menopausal women
bleeding
describe the endometrium
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
what is endometrial cancer
Malignant neoplasm of glandular epithelium = adenocarcinoma
The predominant endometrial cancer arises in the glands of the endometrium
what is morphology
Microscopic appearance
list the sub-types of endometrial adenocarcinoma
Endometrioid
Serous
Clear cell
Mixed (components of the previous 3)
Undifferentiated
Carcinosarcomas
how and why are endometrial adenocarcinomas named?
Endometrioid cancers show differentiation that resembles endometrial glands
Serous cancers were thought to resemble Fallopian tube epithelium
Clear cell cancers have clear cytoplasm
what are the two groups of women with endometrial adenocarcinoma
Type 1 and 2
wat are the characteristics of t1 endometrial adenocarcinomas?
type 1:
Cause-estrogenic stim & anovulatory
Age- 50-60’s
Morphologic types of tumour- Endometroid
Molecular genetic abnormalities-MSI,PTEN, PAX2 Loss
Precursor lesions-EIN, atypical hyperplasia
Prognosis and treatment- good
wat are the characteristics of t2 endometrial adenocarcinomas?
type 1:
Cause- atrophic
Age- 60-70’s
Morphologic types of tumour- serous and mixed
Molecular genetic abnormalities-P53 mut, 1p deletion, PAX2 loss
Precursor lesions-EIC
Prognosis and treatment- Poor
what are precursor lesions that transform into invasive squamous cell carcinoma called?
Cervical Intra-Epithelial Neoplasia (CIN)
The disease process is called dysplasia
what are the risk factors for endometrial cancer
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
aetiology of the factor of endogenous hormones
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
factor of pregnancy
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)
factors of diabetes and insulin
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
what are the exogenous hormones and modulators for HRT
Tamoxifen rr.20
unopposed estrogen RR 6.0
factor of ethnicity
Less common in African-American women
what are the 3 tumour specific parameters and what has majority of this covered?
Tumour type ✔
Tumour grade
Tumour stage
Grading
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
Tumour stage
For all neoplasms a T N M system exist
s
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
how does endometrial cancers spread
Because endometrium has its own stroma, initially malignant glands invade endometrial stroma
Then spreads into the myometrium
Down into the cervix
Where it reaches vessels and spreads via lymphatics or veins to nodes or vagina
FIGO staging
Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis
Summary facts ( p1)
Over 80% of women with endometrial cancer present with post menopausal bleeding
Most ‘endometrial cancers’ arise from endometrial glands and are adenocarcinomas
There are several different types of adenocarcinoma – the most common is called endometrioid because it resembles endometrial glands
summary facts (pt 2)
Other types of endometrial adenocarcinoma can be recognized microscopically
These may have distinct molecular abnormalities and behaviour
Recognizing different types of adenocarcinoma benefits patients since it informs likely prognosis and treatment
Summary facts (pt 3)
Endometrioid cancer has a precursor lesion called atypical hyperplasia
Tumour grading estimates the degree to which the neoplasm matures and informs prognosis and treatment
Tumour staging demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment
summary facts pt 4
Incidence of endometrial cancer has been increasing in the last ten yearsRisk factors include:
- Endogenous hormones and reproductive factors
- Excess body weight
- Diabetes mellitus and insulin
- Exogenous hormones & modulators
- Ethnicity
- Familial (Cowden’s syndrome; HNPCC)
Mortality from endometrial cancer has been falling however, except for women over the age of 85
