Uterine Cancer Flashcards
When are endometrial polyps common?
Around/After menopause
What is atypical endometrial hyperplasia?
Precursor of carcinoma
In terms of Dilation, Component, Glands and Cytology, describe simple endometrial hyperplasia
General
Glands + Stroma
Dilated not crowded
Normal
In terms of Dilation, Component, Glands and Cytology, describe complex endometrial hyperplasia
Focal
Glands
Crowded
Normal
In terms of Dilation, Component, Glands and Cytology, describe atypical endometrial hyperplasia
Focal
Glands
Crowded
Atypical
When does endometrial carciinoma usually occur?
50-60 years
Uncommon under 40
What should be considered in younger women?
Underlying predisposition e.g. PCOS or Lynch syndrome
What is endometrioid carcinoma associated with?
Precursor atypical hyperplasia
What is serous carcinoma associated with?
Precursor serous intraepithelial carcinoma
What do carcinomas usually present with?
Abnormal bleeding
What is seen macroscopically in endometrial carcinoma?
Large uterus
Polypoid
What is seen microscopically in endometrial carcinomas?
Most are adenocarcinomas
Most are well differentiated
What spread is assoc. with endometrial carcinoma?
Directly into myometrium and cervix
Lymphatic
Haematogenous
What are type 1 endometrial carcinoma tumours?
Endometrioid (and mucinous)
What are type 1 tumours assoc. with?
Related to unopposed oestrogen
Atypical hyperplasia
What are type 2 endometrial carcinoma tumours?
Serous (and clear cell)
What are type 2 tumours assoc. with?
Elderly post-menopausal women
TP53 often mutated
Not with unopposed oestrogen
What 3 mutations are often seen in type 1 tumours?
PTEN
KRAS
PIK3CA
What is Lynch syndrome?
Germline mutation of mismatch repair genes
Hereditary non-polyposius colorectal cancer)
Auto dominance
What is a major risk factor for endometrial cancer?
Obesity
Why is obesity a risk factor for endometrial cancer?
Adipocytes express aromatase that converts ovarian adrogens into oestrogens which induce endometrial proliferation
What is lower in obese women?
Sex hormone-binding globulin
What other hormone exerts proliferative effects upon the endometrium?
Insulin
Insulin like growth factor (IGF)
How do type 2 tumours spread?
Along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease
How is serous carcinoma characterised?
Complex papillary and/or glandular architecture with diffuse, marked nuclear polymorphism
Where does endometrial carcinoma usually infiltrate?
Myomerium
Where may endometrial carcinoma spread early to?
Peritoneal cavity
What does the prognosis of endometrial cancer depend on?
Stage
Histological grade
Depth of myometrial invasion
What is the treatment for endometrial carcinoma?
Hysterectomy
Chemo/radiotherapy
What are stage 1, and stage 1Aand 1B endometrial carcinomas?
Stage 1 is confined to the uterus
1A = <50% myometrial invasion
1B = >50%
What is stage 2 endometrial carcinoma?
Tumour invades cervical stoma
What is stage 3, 3A, 3B and 3C endometrial carcinoma?
Local or regional tumour spread
3A = invades serosa of uterus and/or adnexae
3B = vaginal and/or parametrial involvement
3C = Mets to pelvic and/or para-aortic lymph nodes
What is stage 4 endometrial cancer?
Invades bladder and/or bowel mucosa (IVA) and/or distant mets (IVB)
Where does an endometrial stromal sarcoma arise from?
Endometrial stroma
What is a carcinosarcoma?
Mixed tumour with malignant epithelial and stromal elements
What means a carcinosarcoma has the worst possible prognosis?
Rhabdomyosarcomatous component
Name a fibroid smooth muscle tumour of the myometrium and it’s associations?
Leiomyoma
Mennorhagia and infertility
Name a rarer myometrial smooth muscle tumour?
Leiomyosarcoma
What does a Leiomyosarcoma display?
Spindle cell morphology
When does a leiomyosarcoma occur?
Women >50 years
What are common symptoms for leiomyosarcoma?
Abnormal vaginal bleeding
Palpable pelvic mass
Pelvic pain
What is the 5 year survival rate for leiomyosarcoma?
15-25%
