T3L3 Endometrial cancer

Question 1

what is endometrial cancer?

Answer 1

The predominant endometrial cancer arises in the glands of the endometrium

Question 2

what is an adenocarcinoma?

Answer 2

malignant neoplasm of glandular epithelium

Question 3

what are the subtypes of endometrial adenocarcinoma by morphology?

Answer 3

Endometrioid 
Serous 
Clear cell 
Mixed (components of previous 3)
Undifferentiated 
Carcinosarcomas

Question 4

Why the adenocarcinoma subtypes are named endometrioid, serous, clear cell

Answer 4

Endometrioid cancers show differentiation that resembles endometrial glands
Serous cancers were thought to resemble Fallopian tube epithelium
Clear cell cancers have clear cytoplasm

Question 5

Demographic and histologic studies suggest two groups of women with endometrial adenocarcinoma
what is the difference between type 1 and 2 ?

Answer 5

Type 1 -
the type is endometrioid
occurs in obese younger people 50-60 compared to 60-70
good prognosis with type 1 but poor with type 2
type 1 spread to lymph nodes
type 2 spread to peritoneum

Question 6

In the cervix, we recognize a precursor lesion to invasive squamous cell carcinoma

What is it called?

Answer 6

Cervical Intra-Epithelial Neoplasia (CIN)

and the disease process is called dysplasia

Question 7

risk factors for endometrial cancer?

Answer 7

endogenous hormones 
excess body weight 
diabetes mellitus and insulin 
ethnicity 
familial - Cowdens syndrome

Question 8

is smoking a risk for endometrial cancer?

Answer 8

no

Question 9

How do endogenous hormones/weight provide a risk for endometrial cancer?

Answer 9

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

Question 10

Reproduction and endometrial cancer

Answer 10

pregnancy and parity REDUCE risk of endometrial cancer

mechanism: the break from unopposed oestrogen during pregnancy and the removal of abnormal cells at delivery

Question 11

How do early menarche and late menopause affect risk of endometrial cancer?

Answer 11

increased risk

Question 12

Diabetes/Insulin and endometrial cancer

Answer 12

2 fold inc risk - women with diabetes mellitus

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

Question 13

What exogenous hormones are a risk factor for endometrial cancer?

Answer 13

HRT
tamoxifen
DUE TO UNOPPOSED OESTROGEN

Question 14

Ethnicity

Answer 14

US studies show endometrial carcinoma is less common in African American women

Question 15

Although endometerial cancer is lower in African American women they have higher mortaility.. why?

Answer 15

Later stage at diagnosis
Unfavourable tumour type
Sociodemographic factors and treatment
Comorbidities

Question 16

What is grading?

Answer 16

Grading reflects how much a tumour resembles its parent tissue and estimates the degree to which the neoplasm has matured
well differentiated = 1
moderately differentiaed = 2
poorly differentiated = 3

BENEFIT OF GRADING:
informs prognosis and treatment

Question 17

staging of NEOPLASMS

Answer 17

T- tumour - local spread
N - nodes - lymph node deposits
M - metastasis - metastatic deposits

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

Question 18

for GYNAECOLOGICAL TUMOURS a different system is used for staging

Answer 18

FIGO - staging of endometrial carcinoma
Stage 1: Confined to corpus
Stage 2: Involving cervix
Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes
Stage 4: Bladder, Bowel, Distant Metastasis

Question 19

Spread of endometrial carcinoma

Answer 19

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

Question 20

How do women with endometrial commonly present?

Answer 20

with POST MENOPAUSAL BLEEDING

Question 21

what is the most common type of adenocarcinoma?

Answer 21

endometrioid =

because it resembles endometrial glands

Question 22

Endometrioid cancer has a precursor lesion called….

Answer 22

atypical hyperplasia