Uterine Cancer

Question 1

When is it most common to develop endometrial polyps?

Answer 1

Around or after the menopause

Question 2

What are the 3 subgroups of endometrial hyperplasia?

Answer 2

Simple
Complex
Atypical

Question 3

What causes endometrial hyperplasia?

Answer 3

Unknown but may be persistent oestrogen stimulation

Question 4

How does endometrial hyperplasia typically present?

Answer 4

Bleeding - dysfunctional uterine bleeding or post-menopausal bleeding

Question 5

Endometrial carcinoma is uncommon under the age of 40. True/False?

Answer 5

True
Mainly 50-60 yr olds

Question 6

What are the 2 main groups of endometrial carcinoma and their precursor lesions?

Answer 6

Type 1: endometrioid, derived from atypical hyperplasia
Type 2: serous carcinoma, derived from serous intraepithelial carcinoma

Question 7

Most endometrial carcinoma is what - adenocarcinoma or squamous cell carcinoma?

Answer 7

Adenocarcinoma

Question 8

What causes endometrioid endometrial carcinoma?

Answer 8

Unopposed oestrogen stimulation

Question 9

Which is more common - endometrioid or serous endometrial carcinoma?

Answer 9

Endometrioid

Question 10

What is the biggest risk factor for endometrial cancer?

Answer 10

Obesity

Question 11

Why is obesity associated with endometrial cancer?

Answer 11

Adipocytes express aromatase which converts androgens to oestrogens, inducing endometrial proliferation

Question 12

What is the effect of insulin upon the endometrium?

Answer 12

Exerts proliferative effect on endometrium

Question 13

Which syndrome is related to endometrioid endometrial carcinoma and increases the risk of colorectal cancer?

Answer 13

Lynch syndrome
AKA hereditary non-polyposis colorectal cancer

Question 14

What is the genetic abnormality in lynch syndrome?

Answer 14

Autosomal dominant mutation in DNA mismatch repair gene

Question 15

What should be tested for in cancer tissue in someone with lynch syndrome?

Answer 15

Microsatellite instability (MSI)

Question 16

Serous endometrial carcinoma is more aggressive/invasive than endometrioid endometrial carcinoma. True/False?

Answer 16

True

Question 17

What does the prognosis of endometrial cancer depend on?

Answer 17

Staging
Histological grading
Depth of myometrial invasion

Question 18

How is endometrioid endometrial carcinoma graded?

Answer 18

By architecture
Grade 1: 5% or less solid growth
Grade 2: 6-50% solid growth
Grade 3: above 50% solid growth

Question 19

How is serous endometrial carcinoma graded?

Answer 19

It’s not!
It’s high-grade by nature

Question 20

Describe a stage 1 endometrial cancer

Answer 20

Confined to uterus
IA: no or less than 50% invasion
IB: invasion more than or equal to 50%

Question 21

Describe a stage 2 endometrial cancer

Answer 21

Invasion of cervical stroma

Question 22

Describe a stage 3 endometrial cancer

Answer 22

Local or regional spread
IIIA: serosa of uterus and/or adnexae
IIIB: vaginal involvement
IIIC: pelvic/para-aortic lymoh node spread

Question 23

Describe a stage 4 endometrial cancer

Answer 23

Invasion of bladder or bowel mucosa and/or distant metastases

Question 24

What are the 2 main myometrial tumours that can occur?

Answer 24

Leiomyoma (benign, common)
Leiomyosarcoma (malignant, rare)

Question 25

What is another name for a leiomyoma?

Answer 25

Uterine fibroid

Question 26

What is the most common uterine sarcoma?

Answer 26

Leiomyosarcoma