Uterine Cancer

Question 1

List two endometrial causes of dysfunctional uterine bleeding

Answer 1

Endometrial polyps

Endometrial hyperplasia

Question 2

When is it most common to develop endometrial polyps?

Answer 2

Around or after the menopause

Question 3

What are the 3 subgroups of endometrial hyperplasia?

Answer 3

Simple
Complex
Atypical (precursor of carcinoma)

Question 4

What causes endometrial hyperplasia?

Answer 4

Unknown but may be persistent oestrogen stimulation (HRT, tamoxifen)

Question 5

Describe the pathology of simple endometrial hyperplasia, discussing distribution, components, gland appearance and cytology

Answer 5

Generalised distribution
Glands and stroma involved
Dilated glands
Normal cytology

Question 6

Describe the pathology of complex endometrial hyperplasia, discussing distribution, components, gland appearance and cytology

Answer 6

Focal distribution
Glands involved
Crowded glands
Normal cytology

Question 7

Describe the pathology of atypical endometrial hyperplasia, discussing distribution, components, gland appearance and cytology

Answer 7

Focal distribution
Glands involved
Crowded glands
Atypical cytology

Question 8

How does endometrial hyperplasia typically present?

Answer 8

Bleeding - dysfunctional uterine bleeding or post-menopausal bleeding

Question 9

Endometrial carcinoma is uncommon under the age of 40. True/False?

Answer 9

True

Mainly 50-60 yr olds who are obese

Question 10

In young women with endometrial carcinoma, what diagnoses should be considered?

Answer 10

Lynch syndrome

PCOS

Question 11

Outline the typical spread of endometrial carcinoma

Answer 11

Directly into myometrium and cervix

Lymphatic, haematogenous

Question 12

What are the 2 main groups of endometrial carcinoma and their precursor lesions?

Answer 12

Type 1: endometrioid, derived from atypical hyperplasia

Type 2: serous carcinoma, derived from serous intraepithelial carcinoma

Question 13

Serous carcinomas are usually found in…

Answer 13

Elderly post-menopausal women

Question 14

Outline the pathological features of endometrioid carcinoma

Answer 14

Pink bands of endometrium

Saw-tooth glands that invade myometrium

Question 15

Outline the pathological features of serous carcinoma

Answer 15

Complex papillary +/- glandular architecture

Diffuse marked nuclear polymorphism

Question 16

Most endometrial carcinoma is what - adenocarcinoma or squamous cell carcinoma?

Answer 16

Adenocarcinoma

Question 17

What causes endometrioid endometrial carcinoma?

Answer 17

Unopposed oestrogen stimulation

Question 18

Which is more common - endometrioid or serous endometrial carcinoma?

Answer 18

Endometrioid (80%)

Question 19

What is the biggest risk factor for endometrial cancer?

Answer 19

Obesity

Question 20

Why is obesity associated with endometrial cancer?

Answer 20

Adipocytes express aromatase which converts androgens to oestrogens, inducing endometrial proliferation

Question 21

What is the effect of insulin upon the endometrium?

Answer 21

Exerts proliferative effect on endometrium

Question 22

Which syndrome is related to endometrioid endometrial carcinoma and increases the risk of colorectal cancer?

Answer 22

Lynch syndrome

AKA hereditary non-polyposis colorectal cancer

Question 23

What is the genetic abnormality in lynch syndrome?

Answer 23

Autosomal dominant mutation in DNA mismatch repair gene

Question 24

What should be tested for in cancer tissue in someone with lynch syndrome?

Answer 24

Microsatellite instability (MSI)
Immunohistochemistry

Question 25

Serous endometrial carcinoma is more aggressive/invasive than endometrioid endometrial carcinoma. True/False?

Answer 25

True | Spreads early to peritoneal cavity

Question 26

What does the prognosis of endometrial cancer depend on?

Answer 26

Staging Histological grading Depth of myometrial invasion

Question 27

How is endometrioid endometrial carcinoma graded?

Answer 27

By architecture Grade 1: 5% or less solid growth Grade 2: 6-50% solid growth Grade 3: above 50% solid growth

Question 28

How is serous endometrial carcinoma graded?

Answer 28

It's not! | It's high-grade by nature (similar to grade 3)

Question 29

Describe a stage 1 endometrial cancer

Answer 29

Confined to uterus IA: no or less than 50% invasion IB: invasion more than or equal to 50%

Question 30

Describe a stage 2 endometrial cancer

Answer 30

Invasion of cervical stroma

Question 31

Describe a stage 3 endometrial cancer

Answer 31

Local or regional spread IIIA: serosa of uterus and/or adnexae IIIB: vaginal involvement IIIC: pelvic/para-aortic lymph node spread

Question 32

Describe a stage 4 endometrial cancer

Answer 32

Invasion of bladder or bowel mucosa and/or distant metastases

Question 33

State two other less common endometrial cancers

Answer 33

Endometrial stroma sarcoma (endometrial stroma) | Carcinosarcoma (epithelial and stromal elements)

Question 34

Which endometrial cancer commony presents with metastases?

Answer 34

Endometrial stroma sarcoma

Question 35

Which endometrial cancer commonly protrudes through the cervical canal?

Answer 35

Carcinosarcoma

Question 36

Which endometrial cancer is associated with heterologous elements, such as rhabdomyosarcoma, chondrosarcoma and osteosarcoma?

Answer 36

Carcinosarcoma

Question 37

What are the 2 main myometrial tumours that can occur?

Answer 37

Leiomyoma (benign, common) | Leiomyosarcoma (malignant, rare)

Question 38

What is another name for a leiomyoma?

Answer 38

Uterine fibroid

Question 39

How does a leiomyoma usually present?

Answer 39

Menorrhagia | Infertility

Question 40

What is the most common uterine sarcoma?

Answer 40

Leiomyosarcoma

Question 41

How does a leioyosarcoma usually present?

Answer 41

Women over 50 with abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

Question 42

What is the mainstay of treatment for endometrial cancer?

Answer 42

Hysterectomy +/- salpingo-oophorectomy +/- removal of lymph nodes Pelvic washings Adjuvant radiotherapy (external beam, brachytherapy) Adjuvant chemotherapy

Question 43

What is the first-line treatment for 1A1 stage disease?

Answer 43

Staging surgery Progestin therapy for fertility preservation Vaginal brachytherapy if not fertility preserving

Question 44

What is the first-line treatment for 1B/2 stage disease?

Answer 44

Staging surgery

Question 45

What is the first-line treatment for 3/4 stage disease?

Answer 45

Staging surgery | Chemotherapy