Uterine Cancer Flashcards
What are the most common causes of dysfunctional uterine bleeding?
Endometrial polyps
Endometrial hyperplasia
What are polyps? When do they normally occur? What do they contain?
- overgrowth of endometrium
- contain glands and stroma
- typically benign but can be malignant
- often occur around or after the menopause
If cytology is atypical there is a low risk of progression to cancer. TRUE/FALSE?
FALSE
- high risk of progression to endometrial cancer
Describe the difference in histological appearance between simple and complex endometrial hyperplasia?
SIMPLE
- glands irregular shaped rather than round
- glands dilated but not crowded
- Lots of stroma visible
COMPLEX
- glands crowded and push stroma away
=> not much stroma present
- normal nuclei lining up along bottom of cells (as complex hyperplasia is not atypical)
Cytology in both simple and complex endometrial hyperplasia is normal. TRUE/FALSE?
TRUE
If cytology is abnormal and there is a high risk of developing endometrial cancer what treatment is offered?
Hysterectomy
as long as no contraindications
What signs on histology of endometrial hyperplasia would indicate that malignancy is present?
- once glands start to fuse
What is thought to cause endometrial hyperplasia?
Causes: often unknown
BUT may be persistent oestrogen stimulation
At what age is endometrial carcinoma most common?
Peak incidence 50 ‐ 60 years
uncommon under 40
If a younger woman was to present with endometrial carcinoma, what underlying causes may you consider?
- Polycystic ovary syndrome (PCOS)
- Lynch syndrome (Hereditary Non-Polyposis Colorectal Cancer)
Patients with Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer) are just as likely to have their first presentation be an endometrial cancer instead of a colorectal cancer. TRUE/FALSE?
TRUE
- condition is usually picked up on presentation of either cancer
What are the precursor lesions to endometrial cancer?
Endometrioid carcinoma
=> precursor atypical hyperplasia
Serous carcinoma
=> precursor serous intraepithelial carcinoma
How does endometrial carcinoma usually appear macroscopically?
Macroscopic
- Large uterus
- polypoid appearance
How does endometrial carcinoma usually appear microscopically?
• Microscopic
– Most are adenocarcinomas (glandular tissue)
– Most are well differentiated
How do endometrial carcinomas usually spread?
• Spread
– Directly into myometrium and cervix
– Lymphatic
– Haematogenous
What are the 2 main types of endometrial carcinoma?
- Endometrioid (and mucinous) – TYPE 1 tumours (80%)
- Due to unopposed oestrogen
- From atypical hyperplasia - Serous (and clear cell) – TYPE 2 tumours
- Not associated with unopposed oestrogen
- Affect elderly post‐menopausal women
- TP53 often mutated => aggressive cancers
What genetic mutations are associated with Type 1 Endometrioid tumours?
PTEN, KRAS, PIK3CA mutations
Why does obesity increase the risk of endometrial cancer?
- Adipocytes express aromatase
=> converts ovarian androgens into oestrogens
=> endometrial proliferation - Insulin action is often altered in obese women
- insulin-binding globulins = reduced
- free insulin levels = elevated
- Insulin and insulin-like growth factors (IGF) make endometrium proliferate
Why does Lynch syndrome put women at an increased risk of cancer?
- inheritance of a defective DNA mismatch repair gene
=> when cells are proliferating and mutate, they are not removed properly - causes microsatellite instability (short stretches of DNA are not the same across all cells anymore) - this is a symptom of DNA mismatch repair
Lynch Syndrome is Autosomal ___________?
- Autosomal dominant
How do serous endometrial carcinomas spread ?
Spreads along Fallopian tube mucosa and peritoneal surfaces
=> can easily present with extrauterine disease
=> More aggressive than endometrioid carcinoma
Describe the histological appearance of serous endometrial carcinoma?
- complex papillary and/or glandular architecture
- nuclear pleomorphism
- inflammatory cells due to reaction with myometrium
- myometrial invasion
Describe the histological appearance of an endometrial clear cell cancer?
- rounded glands
- cogwheel change (lines into centre of round gland)
Endometroid carcinoma is usually confined to the uterus at presentation. TRUE/FALSE?
TRUE
=> good prognosis
What factors is the prognosis of endometrial carcinoma based upon?
Stage (I-IV)
Histological grade
Depth of myometrial invasion
Describe how endometrioid carcinomas are staged according to their architecture
- if well differentiated - still looks like glandular tissue
- if it gets aggressive, glandular cells forget what type of tissue they are meant to form, and instead form solid sheets
Grade 1 5% or less solid growth
Grade 2 6-50% solid growth
Grade 3 >50% solid growth
How are endometrial tumours usually staged (I-IV)?
I - myometrial invasion
II - cervical stroma invasion
III - Local spread
IV - Distant metastases or invading bladder/bowel
What other endometrial cells can become cancerous?
Endometrial stromal sarcoma
- tumour from mesenchyma
Carcinosarcoma
- Mixed tumour => epithelial and stromal elements
- Still a carcinoma but goes crazy and can form bone, cartilage or neuro tissue
Once a tumour breaches the serosa of the uterus how does it spread?
“falls off”
=> into pelvis
=> onto omentum
=> into Pouch of Douglas
How are carcinosarcomas usually treated and why may this be a problem in the age group this cancer are normally found in?
- Treated like serous carcinomas (aggressive)
- Patient group is normally elderly
=> may not be suitable for surgery/ chemotherapy
How do leiomyomas usually appear macroscopically?
- white/grey colour
- covered by layer of endometrium => will bleed at correct time of month
What symptoms are common when a patient has uterine fibroids?
menorrhagia
infertility
At what age do leiomyosarcomas usually occur and how do they normally present?
> 50 years
- present with abnormal bleeding and a palpable pelvic mass (they are usually large when diagnosed)
Leiomyomas are easily identified macroscopically but are difficult to identify microscopically. TRUE/FALSE?
TRUE
- microscopic appearance looks like almost normal smooth muscle
- spindles just run in slightly different directions
