Uterine Cancer Flashcards
List two endometrial causes of dysfunctional uterine bleeding
Endometrial polyps
Endometrial hyperplasia
When is it most common to develop endometrial polyps?
Around or after the menopause
What are the 3 subgroups of endometrial hyperplasia?
Simple
Complex
Atypical (precursor of carcinoma)
What causes endometrial hyperplasia?
Unknown but may be persistent oestrogen stimulation (HRT, tamoxifen)
Describe the pathology of simple endometrial hyperplasia, discussing distribution, components, gland appearance and cytology
Generalised distribution
Glands and stroma involved
Dilated glands
Normal cytology
Describe the pathology of complex endometrial hyperplasia, discussing distribution, components, gland appearance and cytology
Focal distribution
Glands involved
Crowded glands
Normal cytology
Describe the pathology of atypical endometrial hyperplasia, discussing distribution, components, gland appearance and cytology
Focal distribution
Glands involved
Crowded glands
Atypical cytology
How does endometrial hyperplasia typically present?
Bleeding - dysfunctional uterine bleeding or post-menopausal bleeding
Endometrial carcinoma is uncommon under the age of 40. True/False?
True
Mainly 50-60 yr olds who are obese
In young women with endometrial carcinoma, what diagnoses should be considered?
Lynch syndrome
PCOS
Outline the typical spread of endometrial carcinoma
Directly into myometrium and cervix
Lymphatic, haematogenous
What are the 2 main groups of endometrial carcinoma and their precursor lesions?
Type 1: endometrioid, derived from atypical hyperplasia
Type 2: serous carcinoma, derived from serous intraepithelial carcinoma
Serous carcinomas are usually found in…
Elderly post-menopausal women
Outline the pathological features of endometrioid carcinoma
Pink bands of endometrium
Saw-tooth glands that invade myometrium
Outline the pathological features of serous carcinoma
Complex papillary +/- glandular architecture
Diffuse marked nuclear polymorphism
Most endometrial carcinoma is what - adenocarcinoma or squamous cell carcinoma?
Adenocarcinoma
What causes endometrioid endometrial carcinoma?
Unopposed oestrogen stimulation
Which is more common - endometrioid or serous endometrial carcinoma?
Endometrioid (80%)
What is the biggest risk factor for endometrial cancer?
Obesity
Why is obesity associated with endometrial cancer?
Adipocytes express aromatase which converts androgens to oestrogens, inducing endometrial proliferation
What is the effect of insulin upon the endometrium?
Exerts proliferative effect on endometrium
Which syndrome is related to endometrioid endometrial carcinoma and increases the risk of colorectal cancer?
Lynch syndrome
AKA hereditary non-polyposis colorectal cancer
What is the genetic abnormality in lynch syndrome?
Autosomal dominant mutation in DNA mismatch repair gene
What should be tested for in cancer tissue in someone with lynch syndrome?
Microsatellite instability (MSI) Immunohistochemistry
Serous endometrial carcinoma is more aggressive/invasive than endometrioid endometrial carcinoma. True/False?
True
Spreads early to peritoneal cavity
What does the prognosis of endometrial cancer depend on?
Staging
Histological grading
Depth of myometrial invasion
How is endometrioid endometrial carcinoma graded?
By architecture
Grade 1: 5% or less solid growth
Grade 2: 6-50% solid growth
Grade 3: above 50% solid growth
How is serous endometrial carcinoma graded?
It’s not!
It’s high-grade by nature (similar to grade 3)
Describe a stage 1 endometrial cancer
Confined to uterus
IA: no or less than 50% invasion
IB: invasion more than or equal to 50%
Describe a stage 2 endometrial cancer
Invasion of cervical stroma
Describe a stage 3 endometrial cancer
Local or regional spread
IIIA: serosa of uterus and/or adnexae
IIIB: vaginal involvement
IIIC: pelvic/para-aortic lymph node spread
Describe a stage 4 endometrial cancer
Invasion of bladder or bowel mucosa and/or distant metastases
State two other less common endometrial cancers
Endometrial stroma sarcoma (endometrial stroma)
Carcinosarcoma (epithelial and stromal elements)
Which endometrial cancer commony presents with metastases?
Endometrial stroma sarcoma
Which endometrial cancer commonly protrudes through the cervical canal?
Carcinosarcoma
Which endometrial cancer is associated with heterologous elements, such as rhabdomyosarcoma, chondrosarcoma and osteosarcoma?
Carcinosarcoma
What are the 2 main myometrial tumours that can occur?
Leiomyoma (benign, common)
Leiomyosarcoma (malignant, rare)
What is another name for a leiomyoma?
Uterine fibroid
How does a leiomyoma usually present?
Menorrhagia
Infertility
What is the most common uterine sarcoma?
Leiomyosarcoma
How does a leioyosarcoma usually present?
Women over 50 with abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
What is the mainstay of treatment for endometrial cancer?
Hysterectomy +/- salpingo-oophorectomy +/- removal of lymph nodes
Pelvic washings
Adjuvant radiotherapy (external beam, brachytherapy)
Adjuvant chemotherapy
What is the first-line treatment for 1A1 stage disease?
Staging surgery
Progestin therapy for fertility preservation
Vaginal brachytherapy if not fertility preserving
What is the first-line treatment for 1B/2 stage disease?
Staging surgery
What is the first-line treatment for 3/4 stage disease?
Staging surgery
Chemotherapy
