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Repro > Uterine Cancer > Flashcards

Uterine Cancer Flashcards

1
Q

What are 3 types of endometrial hyperplasia and which is the precursor of adenocarcinoma?

A

Simple, complex or atypical - atypical is precursor

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2
Q

How does endometrial hyperplasia present?

A

Abnormal bleeding - either dysfunctional uterine bleeding or postmenopausal bleeding

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3
Q

Outline the distribution, component, glands and cytology of simple endometrial hyperplasia.

A

Distribution: general
Component: glands & stroma
Glands: dilated not crowded
Cytology: normal

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4
Q

Outline the distribution, component, glands and cytology of complex endometrial hyperplasia

A

Distribution: focal
Component: glands
Glands: crowded
Cytology: normal

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5
Q

Outline the distribution, component, glands and cytology of atypical endometrial hyperplasia.

A

Distribution: focal
Component: glands
Glands: crowded
Cytology: atypical

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6
Q

What is the peak age group for endometrial carcinoma and under what age is it uncommon?

A

Peak age 50-60, uncommon <40

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7
Q

What are 2 underlying syndromes you should consider in young women presenting with endometrial carcinoma?

A

PCOS or Lynch Syndrome

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8
Q

The two main types of endometrial carcinoma are endometrioid carcinoma and the more aggressive serous carcinoma. What are their respective precursor lesions?

A

Endometrioid - atypical hyperplasia

Serous - serous intraepithelial carcinoma

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9
Q

How does endometrial carcinoma present macroscopically?

A

Enlarged uterus and may be polypoid growth in cavity

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10
Q

How do endometrial carcinomas spread? (3)

A

Directly into myometrium and cervix, lymphatic and haematogenous

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11
Q

How are endometrioids graded?

A

Grade 1 - 3 based on how many glands are in it so is based on differentiation

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12
Q

Type I tumours make up approx. 80% of endometrial adenocarcinomas. Which two phenotypes of endometrial carcinoma are type 1 tumours?

A

Mostly endometrioid and some mucinous

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13
Q

What is thought to cause Type I endometrial carcinoma?

A

Unopposed oestrogen

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14
Q

Type II tumours make up approx. 20% of endometrial adenocarcinomas. What are the 2 phenotypes for Type II?

A

Serous mostly and some clear cell

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15
Q

Type II endometrial carcinomas are associated with unopposed oestrogen in elderly post-menopausal women. True/false?

A

False! Not associated with unopposed oestrogen but is in elderly post-menopausal women

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16
Q

What 3 mutations are associated with Type I endometrial carcinomas?

A

PTEN, KRAS, PIK3CA

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17
Q

What is the buzzoword for the histological appearance of endometrioid endometrial carcinomas

A

Sawtooth luminal appearance and glands packed in together

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18
Q

Outline the link between obesity and endometrioid endometrial carcinoma in terms of adipocytes

A

Excess adipose tissue causes it because adipoctyes express aromatase that converts ovarian androgens into oestrogens

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19
Q

Outline the link between obesity and endometrioid endometrial carcinoma in terms of SHBG

A

SHBG is lower in obese women so more unbound, biologically active oestrogen

20
Q

Outline the link between obesity and endometrioid endometrial carcinoma in terms of insulin

A

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

21
Q

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?

A

30%

High risk colorectal carcinoma and increased risk of ovarian

22
Q

Explain Lynch syndrome genetically

A

Autosomal dominant inheritance of a defective DNA mismatch repair gene

23
Q

What investigations are done on the tumour to help identify tumours due to Lynch syndrome?

A

Immunohistochemistry staining for mismatch repair proteins and testing for microsatellite instability

24
Q

What gene are Type II endometrial carcinomas associated with?

A

TP53 mutation and overexpression

25
Q

How do Type II tumours spread and how does this affect their presentation?

A

Spread along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease

26
Q

Describe the histological appearance of serous carcinoma

A

Complex papillary and/or glandular architecture with diffuse nuclear pleomorphism, the serous carcinomas are surrounded by inflammatory cells

27
Q

What is buzzword for histological appearance of clear cell type II tumour?

A

Tubulocystic

28
Q

Outline parameters for endometrial cancer staging IA and IB

A

IA - tumour infiltrated inner half of myometrium and IIB - tumour infiltrated outer half

29
Q

What does the prognosis of endometrial carcinoma depend on? (3)

A

Stage (I-IV), histological grade and depth of myometrial invasion

30
Q

What are the treatments for endometrial carcinomas?

A

Hysterectomy; chemo/radiotherapy

31
Q

Outline parameters for grades 1-3 of endometrioid endometrial carcinomas

A

Grade 1: 5% or less solid growth
Grade 2: 6-50% solid growth
Grade 3: >50% solid growth

32
Q

Serous carcinoma and clear cell carcinoma are not formally graded. True/false?

A

True - automatically assumed high grade

33
Q

Outline parameter for endometrial cancer staging II

A

Tumour invades cervical stroma

34
Q

Outline parameters for endometrial cancer staging III, IIIA, IIIB, IIIC

A

III - local or regional tumour spread
IIIA - invades serosa of uterus +/ adnexae
IIIB - vaginal +/ parametrial involvement
IIIC - metastases to pelvic +/ para-aortic lymph nodes

35
Q

Outline parameter for endometrial cancer staging IV, IVA and IVB

A

IV - Tumour invades bladder
IVA - bowel mucosa
IVB - distant mets

36
Q

What is the name of the quite rare tumours arising from the endometrial stroma?

A

Endometrial stromal sarcoma

37
Q

Where do endometrial stromal sarcomas infiltrate? (2)

A

Myometrium and lymphovascular spaces

38
Q

Prognosis of endometrial stromal sarcoma depends on staging. High grade more likely to die. How does endometrial stromal sarcoma sarcoma present?

A

Typically with AUB but initial presentation may be as metastasis, most commonly ovary or lung

39
Q

Carcinomasarcomas used to be known as malignant mixed Müllerian tumour. What are they?

A

Mixed tumour with malignant epithelial and stromal elemts

40
Q

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?

A

Rhabdomyosarcomatous (worst prognosis), chondrosarcoma and osteosarcoma

41
Q

Leiomyomata commonly develop into leiomyosarcomas. true/false?

A

False - rare, account for 1-2% of all uterine malignancies

42
Q

How do leiomyomas present histologically?

A

Swirling muscle tissues

43
Q

Leiomyosarcomas usually occur at what age?

A

women >50yrs

44
Q

What does leiomyosarcoma commonly display morpholigically?

A

Spindle cell morphology

45
Q

What are commonest symptoms of leiomyosarcoma? (3)

A

Abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

46
Q

Leiomyosarcoma has poor prognosis even if confined to uterus, 5year survival rates 15-25%. True/false?

A

True

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