Uterine Cancer Flashcards
what are the two causes of dysfunctional uterine bleeding?
endometrial polyps - common, occur around / after menopause
endometrial hyperplasia - can be simple, complex or atypical (precursor of carcinoma)
what is shown on this specimen?
endometrial polyp
what causes endometrial hyperplasia?
often unknown, may be persistent oestrogen stimulation
for each different type of endometrial hyperplasia (simple, complex and atypical) what is the distribution, component, glands and cytology?
what is shown on this specimen?
endometrial hyperplasia
identify each type of endometrial hyperplasia on histological slides?
what is the peak incidence of endometrial carcinoma?
50-60 years old - uncommon under 40
if endometrial carcinoma presents in young women, which underlying pathology must you consider?
polycystic ovary syndrome
lynch syndrome
what are the two main groups of endometrial carcinoma with precursor lesions?
endometrioid carcinoma = precursor typical hyperplasia
serous carcinoma = precursor serous intraepithelial carcinoma
how does endometrial carcinoma generally present?
abnormal bleeding
how does endometrial carcinoma look both macroscopically and microscopically?
macroscopic = large uterus; polypoid
microscopic = most are adenocarcinomas and well differentiated
how does endometrial carcinoma often spread?
directly into myometrium and cervix
also lymphatic and haematogenous
what is the name of type 1 (80%) endometrial carcinoma and what is it associated with?
endometrioid (and mucinous)
related to unopposed oestrogen and associated with atypical hyperplasia
what is the name of type 2 (20%) endometrial carcinoma and what is it associated with?
serous (and clear cell)
not associated with unopposed oestrogen, affect elderly post-menopausal women and TP53 often mutated
what gene mutations are associated with type 1 and type 2 endometrial carcinomas?
type 1 = PTEN, KRAS, PIK3CA
type 2 = TP53
lynch syndrome is associated with what type of endometrial carcinoma - type 1 or 2?
type 1
(microsatellite instability - germline mutation of mismatch repair)
what is the main risk factor for endometrial carcinoma and why?
obesity
adipocytes express aromatase that converts ovarian androgens into oestrogens, which induces endometrial proliferation
also sex hormone binding globulin levels low so level of unbound (biologically active) hormone higher and the level of insulin binding globulins is reduced and free insulin levels elevated (insulin exerts proliferative effect on endometrium)
what cancers is Lynch syndrome (autosomal dominant) associated with?
colorectal cancer, endometrial cancer and ovarian cancer
how can it be identified that tumours are due to Lynch syndrome?
immunohistochemistry staining of tumour for mismatch repair proteins
they also show microsatellite instability (MSI), a characteristic of defective mismatch repair so testing for MSI can be useful
why can type II endometrial carcinoma present with extrauterine disease?
because it spreads along fallopian tube mucosa and peritoneal surfaces
what is the difference in aggression and treatment of type I vs type II endometrial cancer?
type II is more aggressive than endometrioid (type I)
in type II, surgery is usually more extensive and adjuvant chemo/radiotherapy used more frequently
what is the basis of treatment for endometrial carcinoma?
hysterectomy; chemo/radiotherapy
how is endometrioid carcinoma primarily graded (histological grade)?
due to their architecture
grade 1 = 5% or less solid growth
grade 2 = 6-50% solid growth
grade 3 = >50% solid growth
*serous carcinoma and clear cell carcinoma are not formally graded
how is endometrial cancer staged?
IA = no or <50% myometrial invasion
IB = invasion equal to or >50% of myometrium
II = invades cervical stroma
III = local or regional spread (A = serosa of uterus and/or adnexae, B = vaginal and/or parametrial involvement, C = metastases to pelvic and/or para-aortic lymph nodes)
IV = tumour invades bladder and/or bowel mucosa (IVA) and/or distant metastases (IVB)
