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Reproduction and Sexual Health > uterine cancer > Flashcards

uterine cancer Flashcards

1
Q

what indicates the presence or absence of atypical hyperplasia?

A

rounder nuclei prominent nucleoli
image shows a preneoplastic lesion

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2
Q

when is peak incidence of endometrial carcinoma?

A
  • 50-60 years
  • uncommon under 40
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3
Q

what are underlying predispositions for young women who get endometrial carcinoma?

A
  • PCOS
  • Lynch Syndrome
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4
Q

2 main groups w different precursor lesions what are these?

A
  • endometriod carcinoma: precursor is atypial hyperplasia
  • serous carcinoma: precursor is serous intraepithelial carcinoma
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5
Q

how does endometrial carcinoma generally present?

A
  • abnormal bleeding
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6
Q

most endometrial carcinoma are what?

A
  • adenocarcinomas -> split up into 2 types type 1 and type 2
  • as endometrium is a glandular epithelium
  • most are well differentiated
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7
Q

where is spread of endometrial cancer most common?

A
  • directly into myometrium and cervix
  • lymphatic
  • haematogenous
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8
Q

2 main clinical pathology types what are they?

A
  • endometriod (and mucinous) - type 1 80%
  • serous (and clear cell) - type 2
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9
Q

endometrioid (and mucinous) cancer is related to what?

A
  • unopposed oestrogen
  • assoc w atypical hyperplasia
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10
Q

serous (and clear cell) is assoc w what?

A
  • no assoc w unopposed oestrogen
  • affect elderly post-menopausal women
  • TP53 often mutated
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11
Q

what mutations are associated with type 1 tumours (endometrial carcinoma)

A
  • endometrioid and mucinous phenotypes are assoc w PTEN, KRAS, PIK3CA mutations
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12
Q

what is an important risk factor to consider in endometrial cancer?

A
  • 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
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13
Q

why is obesity a risk factor in endometrial cancer?

A
  • 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
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14
Q

what is lynch syndrome?

A
  • 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.
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15
Q

what is type II tumours (serous and clear cell phenotypes) associated with?

A
  • 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
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16
Q

what is tx for type II tumour - serous and clear cell types

A
  • surgery more extensive and adjuvant chemo/radiotherapy used more frequently
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17
Q

type 1 tumours are what?

A
  • endometrioid and mucinous phenotypes
18
Q

what is the precursor lesion for type 1 tumours?

A
  • atypical hyperplasia
  • also underlying syndorme - lynch syndrome - germline mutation of mismatch repair genes - increases risk
19
Q

how does endometrial carcinoma spread?

A
  • 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
20
Q

what do the stages of endometrial carcinoma go to?

A
  • stages I-IV
21
Q

if invaded inner half and outer half of myometrium what stage?

A

inner = 1 a
outer = 1b

-> if it invades cervix = 2
-> on to uterine serosa, or fallopian tubes and ovaries = grade 3
-> distant spread = 4

22
Q

what is typical tx for endometrial carcinoma

A
  • hysterectomy
  • chemo/radiotherapy
23
Q

endometrioid carcinoma are primarily graded by their architecture by what grades?

A

grade 1, 2 and 3 based on solid growth
serous carcinoma and clear cell carcinoma are not formally graded

24
Q

what are the other types of endometrial tumours?

A
  • endometrial stromal sarcoma
  • carcinosarcoma - elderly women - poor px - used to be termed malignant mixed mullerian tumour
25
Q

what is the 2 grades of endometrial stromal sarcoma?

A
  • low grade
  • high grade - increased atypica, proliferative activity

-> high grade more likely to die of disease

26
Q

endometrial stromal sarcomas are good at invading what?

A
  • myometrium and often lymphovascular spaces
27
Q

how does endometrial stromal sarcoma present?

A
  • abnormal uterine bleeding but initial presentation may be as metastasis - most commonly ovary or lung
28
Q

pink is what in this image?

A
  • myometrium
29
Q

blue is what in this image?

A
  • stromal infiltration in an endometrial sarcoma
30
Q

what is least common uterine malignancy?

A
  • carcinosarcoma
31
Q

what do carcinosarcoma contain?

A
  • heterologous elements - rhabdomyosarcoma, chondrosarcoma, osteosarcoma
  • also high grade carcinomatous and sarcomatous elements
  • presence of a rhabdomyosarcomatous component has the worst prognosis
32
Q

what is staging used for carcinosarcoma

A
  • same staging system for endometrial cancers
33
Q

does a carcinosarcoma commonly infiltrate myometrium?

A
  • no
34
Q

malignant epithelial components and malignant mesenchymal elements make a tumour called?

A
  • carcinosarcoma
35
Q

abnormalities to consider in the myometrium?

A

smooth muscle tumours
- leiomyoma (fibroid)
very common, assoc w menorrhagia, infertility

  • leiomyosarcoma
    rare! but aggressive
36
Q

leiomyosarcoma account for how many uterine malignancies?

A
  • 1-2%
  • most common uterine sarcoma
  • assoc w poor prognosis even if confined to uterus
  • stage is most powerful prog factor
37
Q

what is age for leiomyosarcoma?

A
  • most occur in women > 50 years
38
Q

on cell morphology for leiomyosarcoma what will you see?

A
  • malignant smooth muscle tumour - commonly displaying a spindle cell morphology
39
Q

common symptoms of a leiomyosarcoma?

A
  • abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
40
Q

leiomyosarcoma and what other kind of sarcoma cancer share the same system which is diff to that for endometrial cancer

A
  • endometrial stromal sarcoma
41
Q

serous and clear cell carcinomas aren’t graded but what are they considered?

A
  • high grade carcinomas

Reproduction and Sexual Health (29 decks)

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