Uterine Cancer Flashcards
When do endometrial polyps occur?
around or after menopause
What are the 3 types of endometrial hyperplasia?
simple
complex
atypical
What defines simple endometrial hyperplasia?
glands + stroma
glands are dilated
normal cytology
What defines complex endometrial hyperplasia?
focal distribution
glands are crowded
no stroma
normal cytology
What defines atypical endometrial hyperplasia?
focal distribution
glands are crowded
no stroma
abnormal cytology
What is the peak age incidence of endometrial carcinoma?
50-60years
What predisposes you do endometrial carcinoma?
Lynch syndrome
PCOS
How does endometrial carcinoma present?
abnormal bleeding
What are the different types of endometrial carcinoma?
both adenocarcinomas:
Endometrioid carcinoma - type 1
Serous and Clear cell - type 2
Describe Endometrioid carcinoma - type 1?
related to unopposed oestrogen
associated with atypical hyperplasia
What is more common Endometrioid carcinoma - type 1 or Serous and Clear cell - type 2?
Endometrioid carcinoma - type 1 - 80%
What are risk factors for Endometrioid carcinoma - type 1?
obesity - adipocytes expresss aromatase that converts androgens -> oestrogen
increase in free insulin levels leads to endometrial proliferation
What causes Serous and Clear cell - type 2?
TP53 mutation and over expression
What is the precursor lesion for Serous and Clear cell - type 2?
serous endometrial intraepithelial carcinoma
How does Serous and Clear cell - type 2 spread?
along the Fallopian tubes mucosa and peritoneal surfaces (so can persent with extra uterine disease)
What is more aggressive Endometrioid carcinoma - type 1 or Serous and Clear cell - type 2?
Serous and Clear cell - type 2
What is the treatment for endometrial carcinoma?
surgery - total abdominal hysterectomy with bilateral salpingoophrectomy and peritoneal washings (TAH-BSO)
radiotherapy as adjuvant
chemo if high grade
How is endometroid carcinoma graded?
grade 1 - 5% or less solid growth
grade 2 - 6-50% solid growth
grade 3 - >50% solid growth (can no longer form glands)
What is an endometrial stromal carcinoma?
can be low grade or high grade and resemble endometrial stroma
it can infiltrate the myometrium and lymphovascular system
How does endometrial stromal carcinoma present?
abnormal bleeding or metastasis - ovary or lung
How do leiomyosarcomas present?
women >50
abnormal vaginal bleeding
palpable pelvic mass
pelvic pain
What is the prognosis of leiomyosarcomas?
poor - even if confined
5yr survival 15-25%
How do leiomyomas present?
pelvic mass and abnormal uterine bleeding
women >40s
What different places can leiomyomas/fibroids present?
submucous subserous intracavitary pedunculated intramural
What medical treatment can be given for fibroids?
mirena
GnRH analogues
progestins - OCP
What surgical treatment can be given for fibroids?
laparotomy/laproscopic
What must be done in an acute presentation of a fibroid degeneration?
myomectomy
subtotal or total hysterectomy
How does endometriosis present?
severe dysmennorhoea
pre menstrual pain
dysparenuia
What are the consequences of endometriosis?
subfertility
ectopic pregnancy
cyst formation pain
malignancy
What is the first line investigation for endometrial cancer?
pipelle biopsy - can do in a GP
What is an endometrioma?
endometriosis in the ovary
What are endometriotic cysts?
endometrium in the wrong place eg ovary
blood filled cysts
What is an adenomyosis?
endometriosis in the myometrium
What are the two types of functional cysts?
follicular or luteal - form when ovulation doesnt occur
Describe functional cysts?
usually <5cm in diameter
asymtomatic and resolve spontaneously
may bleed/rupture and cause pain
lined by grnaulosa cells
