Uterine Cancer

Question 1

when are endometrial polyps common

Answer 1

around/after menopause

Question 2

how does endometrial hyperplasia present

Answer 2

with abnormal bleeding (DUB or postmenopausal bleeding)

Question 3

what are the three types of endometrial hyperplasia

Answer 3

simple, complex and atypical

Question 4

what is the peak incidence of endometrial carcinoma

Answer 4

in 50-60 years, uncommon in under 40

Question 5

if endometrial carcinoma presents in younger women consider

Answer 5

PCOS or Lynch syndrome

Question 6

what is Lynch syndrome

Answer 6

HNPCC

Question 7

how does endometrial carcinoma tend to present

Answer 7

with abnormal bleeding

Question 8

what are the 2 main groups of endometrial carcinoma

Answer 8

endometriod and serous

Question 9

what is the precursor lesion of endometriod carcinoma

Answer 9

atypical hyperplasia

Question 10

what is the precursor of serous ccarcinoma

Answer 10

precursor serous intraepithelial carcinoma

Question 11

what are endometriod cancers related to

Answer 11

unopposed oestrogen

Question 12

endometriod are also called what tumours

Answer 12

type 1 tumours

Question 13

serous (and clear cell) are called what tumours

Answer 13

type 2 tumours

Question 14

are serous endometrial cancers associated with unopposed oestrogen

Answer 14

no

Question 15

what is often mutated in endometrial carcinoma

Answer 15

TP53

Question 16

describe features of type 1 tumours

Answer 16

endometriod and mucinous
PTEN, KRAS, PIK3CA mutations
associated with atypical hyperplasia as a precursor lesion
microsatellite instability
-germline mutation of mismatch repair genes (Lynch syndrome)

Question 17

what is a risk factor for endometrial cancer and why

Answer 17

obesity
adipocytes express aromatase that convert ovarian androgens into oestrogen which induce endometrial proliferation
insulin action is reduced IGF exert a proliferative effect on endometrium

Question 18

Lynch syndrome can increase which type of cancers

Answer 18

colorectal cancer
endometrial cancer
ovarian cancer

Question 19

what causes Lynch syndrome

Answer 19

defective DNA mismatch repair gene

Question 20

how can this type of tumour be identified

Answer 20

IHC of the tumour for mismatch repair proteins

MSI-microsatellite instability

Question 21

features of type II tumours

Answer 21

serous and clear cell
TP53 mutation and overexpression
spreads along fallopian tube mucosa and peritoneal surface so can present with extrauterine disease
more aggressive

Question 22

serous carcinoma pathology

Answer 22

complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism

Question 23

where does endmetriod carcinoma tend to spread

Answer 23

inifiltrates the myometrium

Question 24

how are serous carcinoma graded

Answer 24

not formally graded

Question 25

stage 1 endometrial cancer is typically confined to where

Answer 25

the uterus

Question 26

what is a carcinosarcoma

Answer 26

mixed tumour with malignant epithelial and stromal elements

heterologous elements commonly seen eg rhabdomyosarcoma, chondrosarcoma

Question 27

what can happen as part of a paraneoplastic syndrome with fibroids

Answer 27

polycythaemia