uterine cancer Flashcards
what indicates the presence or absence of atypical hyperplasia?
rounder nuclei prominent nucleoli
image shows a preneoplastic lesion
when is peak incidence of endometrial carcinoma?
- 50-60 years
- uncommon under 40
what are underlying predispositions for young women who get endometrial carcinoma?
- PCOS
- Lynch Syndrome
2 main groups w different precursor lesions what are these?
- endometriod carcinoma: precursor is atypial hyperplasia
- serous carcinoma: precursor is serous intraepithelial carcinoma
how does endometrial carcinoma generally present?
- abnormal bleeding
most endometrial carcinoma are what?
- adenocarcinomas -> split up into 2 types type 1 and type 2
- as endometrium is a glandular epithelium
- most are well differentiated
where is spread of endometrial cancer most common?
- directly into myometrium and cervix
- lymphatic
- haematogenous
2 main clinical pathology types what are they?
- endometriod (and mucinous) - type 1 80%
- serous (and clear cell) - type 2
endometrioid (and mucinous) cancer is related to what?
- unopposed oestrogen
- assoc w atypical hyperplasia
serous (and clear cell) is assoc w what?
- no assoc w unopposed oestrogen
- affect elderly post-menopausal women
- TP53 often mutated
what mutations are associated with type 1 tumours (endometrial carcinoma)
- endometrioid and mucinous phenotypes are assoc w PTEN, KRAS, PIK3CA mutations
what is an important risk factor to consider in endometrial cancer?
- obesity
- excess risk is associated w the endocrine and inflammatory effects of adipose tissue
- therefore weight loss (loss of adipose tissue) are associated w a reduction in risk
why is obesity a risk factor in endometrial cancer?
- adipocytes express aromatase that converts ovarian androgens into oestrogens which induce endometrial proliferation
- sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher…
- along w this insulin action is often altered in obese women: the level of insulin-binding globulins is reduced and free insulin levels are elevated. insulin/insulin-like growth factors (IGF) exert prolliferative effect on endometrium
what is lynch syndrome?
- hereditary non-polyposis colorectal cancer
- cancer predisposition syndrome -> high risk of colorectal cancer and endometrial cancer and inc probability of developing ovarian cancer
- due to the AD inheritance of a defective DNA mismatch repair gene.
what is type II tumours (serous and clear cell phenotypes) associated with?
- TP53 mutation and overexpression
- serous carcinoma has a precursor lesion called serous endometrial intraepithelial carcinoma = abnormality is within the epithelium
- lesion can spread into fallopian tube and onto pertioneal surfaces so can present w extrauterine disease
- more aggressive than endometrioid/mucinous carcinoma
what is tx for type II tumour - serous and clear cell types
- surgery more extensive and adjuvant chemo/radiotherapy used more frequently
type 1 tumours are what?
- endometrioid and mucinous phenotypes
what is the precursor lesion for type 1 tumours?
- atypical hyperplasia
- also underlying syndorme - lynch syndrome - germline mutation of mismatch repair genes - increases risk
how does endometrial carcinoma spread?
- typically infiltrates myometrium and can spread early into the peritoneal cavity
- but has a good prognosis as it is usually confined to the uterus at presentation
what do the stages of endometrial carcinoma go to?
- stages I-IV
if invaded inner half and outer half of myometrium what stage?
inner = 1 a
outer = 1b
-> if it invades cervix = 2
-> on to uterine serosa, or fallopian tubes and ovaries = grade 3
-> distant spread = 4
what is typical tx for endometrial carcinoma
- hysterectomy
- chemo/radiotherapy
endometrioid carcinoma are primarily graded by their architecture by what grades?
grade 1, 2 and 3 based on solid growth
serous carcinoma and clear cell carcinoma are not formally graded
what are the other types of endometrial tumours?
- endometrial stromal sarcoma
- carcinosarcoma - elderly women - poor px - used to be termed malignant mixed mullerian tumour
what is the 2 grades of endometrial stromal sarcoma?
- low grade
- high grade - increased atypica, proliferative activity
-> high grade more likely to die of disease
endometrial stromal sarcomas are good at invading what?
- myometrium and often lymphovascular spaces
how does endometrial stromal sarcoma present?
- abnormal uterine bleeding but initial presentation may be as metastasis - most commonly ovary or lung
pink is what in this image?
- myometrium
blue is what in this image?
- stromal infiltration in an endometrial sarcoma
what is least common uterine malignancy?
- carcinosarcoma
what do carcinosarcoma contain?
- heterologous elements - rhabdomyosarcoma, chondrosarcoma, osteosarcoma
- also high grade carcinomatous and sarcomatous elements
- presence of a rhabdomyosarcomatous component has the worst prognosis
what is staging used for carcinosarcoma
- same staging system for endometrial cancers
does a carcinosarcoma commonly infiltrate myometrium?
- no
malignant epithelial components and malignant mesenchymal elements make a tumour called?
- carcinosarcoma
abnormalities to consider in the myometrium?
smooth muscle tumours
- leiomyoma (fibroid)
very common, assoc w menorrhagia, infertility
- leiomyosarcoma
rare! but aggressive
leiomyosarcoma account for how many uterine malignancies?
- 1-2%
- most common uterine sarcoma
- assoc w poor prognosis even if confined to uterus
- stage is most powerful prog factor
what is age for leiomyosarcoma?
- most occur in women > 50 years
on cell morphology for leiomyosarcoma what will you see?
- malignant smooth muscle tumour - commonly displaying a spindle cell morphology
common symptoms of a leiomyosarcoma?
- abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
leiomyosarcoma and what other kind of sarcoma cancer share the same system which is diff to that for endometrial cancer
- endometrial stromal sarcoma
serous and clear cell carcinomas aren’t graded but what are they considered?
- high grade carcinomas
