Uterine Cancer Flashcards
What are 3 types of endometrial hyperplasia and which is the precursor of adenocarcinoma?
Simple, complex or atypical - atypical is precursor
How does endometrial hyperplasia present?
Abnormal bleeding - either dysfunctional uterine bleeding or postmenopausal bleeding
Outline the distribution, component, glands and cytology of simple endometrial hyperplasia.
Distribution: general
Component: glands & stroma
Glands: dilated not crowded
Cytology: normal
Outline the distribution, component, glands and cytology of complex endometrial hyperplasia
Distribution: focal
Component: glands
Glands: crowded
Cytology: normal
Outline the distribution, component, glands and cytology of atypical endometrial hyperplasia.
Distribution: focal
Component: glands
Glands: crowded
Cytology: atypical
What is the peak age group for endometrial carcinoma and under what age is it uncommon?
Peak age 50-60, uncommon <40
What are 2 underlying syndromes you should consider in young women presenting with endometrial carcinoma?
PCOS or Lynch Syndrome
The two main types of endometrial carcinoma are endometrioid carcinoma and the more aggressive serous carcinoma. What are their respective precursor lesions?
Endometrioid - atypical hyperplasia
Serous - serous intraepithelial carcinoma
How does endometrial carcinoma present macroscopically?
Enlarged uterus and may be polypoid growth in cavity
How do endometrial carcinomas spread? (3)
Directly into myometrium and cervix, lymphatic and haematogenous
How are endometrioids graded?
Grade 1 - 3 based on how many glands are in it so is based on differentiation
Type I tumours make up approx. 80% of endometrial adenocarcinomas. Which two phenotypes of endometrial carcinoma are type 1 tumours?
Mostly endometrioid and some mucinous
What is thought to cause Type I endometrial carcinoma?
Unopposed oestrogen
Type II tumours make up approx. 20% of endometrial adenocarcinomas. What are the 2 phenotypes for Type II?
Serous mostly and some clear cell
Type II endometrial carcinomas are associated with unopposed oestrogen in elderly post-menopausal women. True/false?
False! Not associated with unopposed oestrogen but is in elderly post-menopausal women
What 3 mutations are associated with Type I endometrial carcinomas?
PTEN, KRAS, PIK3CA
What is the buzzoword for the histological appearance of endometrioid endometrial carcinomas
Sawtooth luminal appearance and glands packed in together
Outline the link between obesity and endometrioid endometrial carcinoma in terms of adipocytes
Excess adipose tissue causes it because adipoctyes express aromatase that converts ovarian androgens into oestrogens
Outline the link between obesity and endometrioid endometrial carcinoma in terms of SHBG
SHBG is lower in obese women so more unbound, biologically active oestrogen
Outline the link between obesity and endometrioid endometrial carcinoma in terms of insulin
Lowered insulin action in obesity so insulin-binding globulins reduced and free insulin levels are elevated. Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium
What is the approximate lifetime risk of developing endometrial cancer in patient with Lynch syndrome? What other 2 cancers do they have increased probability of developing?
30%
High risk colorectal carcinoma and increased risk of ovarian
Explain Lynch syndrome genetically
Autosomal dominant inheritance of a defective DNA mismatch repair gene
What investigations are done on the tumour to help identify tumours due to Lynch syndrome?
Immunohistochemistry staining for mismatch repair proteins and testing for microsatellite instability
What gene are Type II endometrial carcinomas associated with?
TP53 mutation and overexpression
How do Type II tumours spread and how does this affect their presentation?
Spread along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease
Describe the histological appearance of serous carcinoma
Complex papillary and/or glandular architecture with diffuse nuclear pleomorphism, the serous carcinomas are surrounded by inflammatory cells
What is buzzword for histological appearance of clear cell type II tumour?
Tubulocystic
Outline parameters for endometrial cancer staging IA and IB
IA - tumour infiltrated inner half of myometrium and IIB - tumour infiltrated outer half
What does the prognosis of endometrial carcinoma depend on? (3)
Stage (I-IV), histological grade and depth of myometrial invasion
What are the treatments for endometrial carcinomas?
Hysterectomy; chemo/radiotherapy
Outline parameters for grades 1-3 of endometrioid endometrial carcinomas
Grade 1: 5% or less solid growth
Grade 2: 6-50% solid growth
Grade 3: >50% solid growth
Serous carcinoma and clear cell carcinoma are not formally graded. True/false?
True - automatically assumed high grade
Outline parameter for endometrial cancer staging II
Tumour invades cervical stroma
Outline parameters for endometrial cancer staging III, IIIA, IIIB, IIIC
III - local or regional tumour spread
IIIA - invades serosa of uterus +/ adnexae
IIIB - vaginal +/ parametrial involvement
IIIC - metastases to pelvic +/ para-aortic lymph nodes
Outline parameter for endometrial cancer staging IV, IVA and IVB
IV - Tumour invades bladder
IVA - bowel mucosa
IVB - distant mets
What is the name of the quite rare tumours arising from the endometrial stroma?
Endometrial stromal sarcoma
Where do endometrial stromal sarcomas infiltrate? (2)
Myometrium and lymphovascular spaces
Prognosis of endometrial stromal sarcoma depends on staging. High grade more likely to die. How does endometrial stromal sarcoma sarcoma present?
Typically with AUB but initial presentation may be as metastasis, most commonly ovary or lung
Carcinomasarcomas used to be known as malignant mixed Müllerian tumour. What are they?
Mixed tumour with malignant epithelial and stromal elemts
Carcinosarcomas make up <5% of uterine malignancies and can be carcinomatous and sarcomatous. What 3 types of sarcomas can be seen and which indicated worst prognosis?
Rhabdomyosarcomatous (worst prognosis), chondrosarcoma and osteosarcoma
Leiomyomata commonly develop into leiomyosarcomas. true/false?
False - rare, account for 1-2% of all uterine malignancies
How do leiomyomas present histologically?
Swirling muscle tissues
Leiomyosarcomas usually occur at what age?
women >50yrs
What does leiomyosarcoma commonly display morpholigically?
Spindle cell morphology
What are commonest symptoms of leiomyosarcoma? (3)
Abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
Leiomyosarcoma has poor prognosis even if confined to uterus, 5year survival rates 15-25%. True/false?
True
