Uterine Cancer Flashcards
What are the causes of dysfunctional uterine bleeding?
- endometrial polyps
- endometrial hyperplasia (simple, complex, atypical)
What are endometrial polyps?
benign outgrowth of the glands and stroma which undergo the same cyclical changes as the endometrium
What can be a potential cause of endometrial hyperplasia?
persistent oestrogen stimulation (HRT, PCOS)
What are the histological features of simple hyperplasia?
glands that are cystically dilated because they continue to grow
When would simple hyperplasia commonly occur?
Around menopause because the glands continue to grow due to low levels of oestrogen
What are the histological features of complex atypical hyperplasia?
- darker nuclei
- rounder cells
At what age does endometrial cancer usually occur?
50-60. <40 is rare
What underlying predisposition could be a cause of endometrial cancer in younger women?
- PCOS
- Lynch syndrome
What are the two main types of endometrial cancer?
type 1 tumours-endometrioid (and mucinous) carcinoma
type 2 tumours-serous carcinoma (and clear cell)
carcinoma
What are the features of endometrial carcinoma?
macroscopic: large uterus
microscopic: most are adenocarcinomas (from glands)
spread: directly into myometrium/cervix, lymphatics, haematogenous
How does endometrial cancer usually present?
-abnormal bleeding
What are the features of endometrioid carcinoma?
- related to unopposed oestrogen
- associated with atypical hyerplasia
- good prognosis, usually limited to the uterus at presentation
What are the features of serous carcinoma?
- NOT due to unopposed oestrogen
- affect elderly post-menopausal women
- TP53 often mutated
- due to microsatellite instability (germline mutation of mismatch repair genes-lynch syndrome)
- spreads along fallopian tube mucosa and peritoneal surfaces
- more aggressive than endometrioid ca
What are the risk factors for endometrial cancer?
- obesity
- lynch syndrome
How does obesity increase the risk of endometrial cancer?
- endocrine and inflammatory effects of adipose tissue
- adipocytes convert ovarian androgens into oestrogens which induce uterine proliferation
- sex hormone binding globulin reduced in obese women so free, biologically active hormone is higher
- insulin binding globulin reduced so free insulin levels are higher. insulin and insulin-like growth factor causes endometrium to proliferate
What is lynch syndrome (hereditary non-polyposis colorectal cancer)?
-it is a cancer predisposition syndrome which increases risk of colorectal cancer, endometrial and
ovarian caner
How can lynch syndrome be determined as the cause of cancer?
- immunohistochemistry staining of tumour for mismatch repair proteins
- tumours may show microsatellite instability (characteristic of defective mismatch repair)
What are the histological features of serous carcinoma?
-complex papillary/glandular architecture with diffuse, marked nuclear pleomorphism
What is the treatment for endometrial cancer?
- hysterectomy if tumour has not breached serosa (perimetrium)
- chemotherapy
- radiotherapy
What is endometrial stromal sarcoma
- rare form of endometrial cancer
- cells resemble stromal cells
- often infiltrate myometrium and lymphovascular space
How does endometrial stromal sarcoma usually present?
- abnormal uterine bleeding
- usually symptoms of metastasis (ovary/lung)
What is endometrial carcinosarcoma?
- high grade carcinomatous and sarcomatous element
- commonly occur in older women
What is a common feature in endometrial carcinosarcoma?
-heterologous elements (rhabdomyosarcoma, chondrosarcoma, osteosarcoma)
What is the prognosis of endometrial carcinosarcoma?
poor outcome
