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Y3 OBS AND GYNAE > Uterine Cancer > Flashcards

Uterine Cancer Flashcards

1
Q

List two endometrial causes of dysfunctional uterine bleeding

A

Endometrial polyps

Endometrial hyperplasia

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2
Q

When is it most common to develop endometrial polyps?

A

Around or after the menopause

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3
Q

What are the 3 subgroups of endometrial hyperplasia?

A

Simple
Complex
Atypical (precursor of carcinoma)

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4
Q

What causes endometrial hyperplasia?

A

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

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5
Q

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

A

Generalised distribution
Glands and stroma involved
Dilated glands
Normal cytology

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6
Q

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

A

Focal distribution
Glands involved
Crowded glands
Normal cytology

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7
Q

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

A

Focal distribution
Glands involved
Crowded glands
Atypical cytology

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8
Q

How does endometrial hyperplasia typically present?

A

Bleeding - dysfunctional uterine bleeding or post-menopausal bleeding

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9
Q

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

A

True

Mainly 50-60 yr olds who are obese

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10
Q

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

A

Lynch syndrome

PCOS

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11
Q

Outline the typical spread of endometrial carcinoma

A

Directly into myometrium and cervix

Lymphatic, haematogenous

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12
Q

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

A

Type 1: endometrioid, derived from atypical hyperplasia

Type 2: serous carcinoma, derived from serous intraepithelial carcinoma

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13
Q

Serous carcinomas are usually found in…

A

Elderly post-menopausal women

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14
Q

Outline the pathological features of endometrioid carcinoma

A

Pink bands of endometrium

Saw-tooth glands that invade myometrium

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15
Q

Outline the pathological features of serous carcinoma

A

Complex papillary +/- glandular architecture

Diffuse marked nuclear polymorphism

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16
Q

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

A

Adenocarcinoma

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17
Q

What causes endometrioid endometrial carcinoma?

A

Unopposed oestrogen stimulation

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18
Q

Which is more common - endometrioid or serous endometrial carcinoma?

A

Endometrioid (80%)

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19
Q

What is the biggest risk factor for endometrial cancer?

A

Obesity

20
Q

Why is obesity associated with endometrial cancer?

A

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

21
Q

What is the effect of insulin upon the endometrium?

A

Exerts proliferative effect on endometrium

22
Q

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

A

Lynch syndrome

AKA hereditary non-polyposis colorectal cancer

23
Q

What is the genetic abnormality in lynch syndrome?

A

Autosomal dominant mutation in DNA mismatch repair gene

24
Q

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

A 
Microsatellite instability (MSI)
Immunohistochemistry
25
Q

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

A

True

Spreads early to peritoneal cavity

26
Q

What does the prognosis of endometrial cancer depend on?

A

Staging
Histological grading
Depth of myometrial invasion

27
Q

How is endometrioid endometrial carcinoma graded?

A

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

28
Q

How is serous endometrial carcinoma graded?

A

It’s not!

It’s high-grade by nature (similar to grade 3)

29
Q

Describe a stage 1 endometrial cancer

A

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

30
Q

Describe a stage 2 endometrial cancer

A

Invasion of cervical stroma

31
Q

Describe a stage 3 endometrial cancer

A

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

32
Q

Describe a stage 4 endometrial cancer

A

Invasion of bladder or bowel mucosa and/or distant metastases

33
Q

State two other less common endometrial cancers

A

Endometrial stroma sarcoma (endometrial stroma)

Carcinosarcoma (epithelial and stromal elements)

34
Q

Which endometrial cancer commony presents with metastases?

A

Endometrial stroma sarcoma

35
Q

Which endometrial cancer commonly protrudes through the cervical canal?

A

Carcinosarcoma

36
Q

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

A

Carcinosarcoma

37
Q

What are the 2 main myometrial tumours that can occur?

A

Leiomyoma (benign, common)

Leiomyosarcoma (malignant, rare)

38
Q

What is another name for a leiomyoma?

A

Uterine fibroid

39
Q

How does a leiomyoma usually present?

A

Menorrhagia

Infertility

40
Q

What is the most common uterine sarcoma?

A

Leiomyosarcoma

41
Q

How does a leioyosarcoma usually present?

A

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

42
Q

What is the mainstay of treatment for endometrial cancer?

A

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

43
Q

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

A

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

44
Q

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

A

Staging surgery

45
Q

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

A

Staging surgery

Chemotherapy

Y3 OBS AND GYNAE (44 decks)

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