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Reproductive & Sexual Health > Uterine Cancer > Flashcards

Uterine Cancer Flashcards

1
Q

What causes dysfunctional uterine bleeding?

A
  • endometrial polyps
    • common
    • often occur around/after the menopause
  • endometrial hyperplasia
    • simple
    • complex
    • atypical (precursor of carcinoma)
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2
Q

What causes endometrial hyperplasia?

A

Often unknown, persistent oestrogen stimulation

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3
Q

How does endometrial hyperplasia present?

A

Abnormal bleeding (DUB or postmenopausal bleeding)

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4
Q

Describe simple endometrial hyperplasia

A

General distribution

Glands and stroma

Glands are dilated, not crowded

Cytology appears normal

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5
Q

Describe complex endometrial hyperplasia?

A

Focal distribution

Glands involved

Glands are crowded

Cytology is normal

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6
Q

Describe atypical endometrial hyperplasia

A

Focal distribution

Glands involved

Glands ar crowded

Atypical cytology

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7
Q

What is the peak incidence of endometrial carcinoma?

A

50-60, uncommon under 40

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8
Q

In young women with suspected endometrial carcinoma what should be considered?

A

Underlying predisposition;

  • PCOS
  • Lynch syndrome
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9
Q

What are the two main groups and different precursor lesions (of endometrial carcinoma)?

A

Endometroid carcinoma: precursor atypical hyperplasia

Serous carcinoma: precursor serous intraepithelial carcinoma

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10
Q

How does endometrial carcinoma usually present?

A

Atypical bleeding

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11
Q

Decribe the macroscopic appearance of endometrial carcinoma?

A

Large uterus; polypoid

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12
Q

Decribe the microscopic appearance of endometrial carcinoma?

A

Most are adenocarcinomas

Most are well differentiated

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13
Q

How does endometrial carcinoma spread?

A

Directly into myometrium and cervix

Lymphatics

Haematogenous

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14
Q

________ ( and ______) are type 1 endometrial carcinomas, accounting for __%

________ ( and ____ __) are type 2 endometrial carcinomas

A

Endometroid (and mucinous) are type 1 endometrial carcinomas, accounting for 80%

Serous ( and clear cell) are type 2 endometrial carcinomas

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15
Q

What are type 1 endometrial carcinomas associated with

A

Unopposed oestrogen

Associated with atypical hyperplasia

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16
Q

Who is affected by type 2 endometrial carcinomas?

A

Elderly post-menopausal women

TP53 often mutated

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17
Q

What mutations are associated with endometrial carcinomas?

A

PTEN, KRAS, PIK3CA

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18
Q

What type of instability is endometrial carcinoma associated with?

A

Microsatellite instability

  • germiline mutation of mismatch repair genes (lynch syndrome)
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19
Q

What is a microsatellite

A

A microsatellite is a tract of repetitive DNA in which certain DNA motifs (ranging in length from one to six or more base pairs) are repeated, typically 5–50 times

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20
Q

Why is obesity a risk factor for endometrial cancer?

A

Endocrine and inflammatory effects of adipose tissue

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21
Q

How do adipocytes stimulate endometrial proliferation?

A

Express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation

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22
Q

Why is the level of biologically active hormone higher in obese women?

A

Sex hormone-binding globulin levels are lower in obese women, therefore the level of unbound biologically active hormone is higher

23
Q

How does altered insulin action in obese women predispose to endometrial cancer?

A

The level of insulin binding globulins is reduced and free insulin levels are elevated. Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium

24
Q

What is lynch syndrome?

A

Hereditary non-polyposis colorectal cancer

High risk of endometrial (lifetime risk of 28%) and an increased probalility of developing ovarian cancer

25
Q

What causes lynch syndrome?

A

Inheritance of defective DNA mismatch repair gene. autosomal dominant inheritance.

26
Q

How can lynch syndrome tumours be identified?

A

Immunohistochemistry staining of the tumour for mismatch repair proteins can help identify them

Test cancer tissue for microsatellite instability

27
Q

What mutations are type II endometrial carcinomas associated with?

A

TP52 mutation and overexpression

28
Q

How do type II tumours spread?

A

Spreads along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease

29
Q

Type II endometrial carcinoma is more aggressive than ________/________ carcinoma

A

Type II endometrial carcinoma is more aggressive than endometroid/mucinous carcinoma

30
Q

What is the treatment for type II endometrial carcinoma?

A

Extensive surgery and adjuvant chemo/radiotherapy

31
Q

How is serous carcinoma characterised?

A

By a complex papillary and/or glandular architecture with diffuse, marked nuclear polymorphism

32
Q

Endometrial carcinoma typically infiltrates what?

A

Myometrium

33
Q

Serous carcinoma may spread early to the ?

A

Peritoneal cavity

34
Q

Why does endometroid carcinoma have a good prognosis?

A

Is usually confined to uterus at presentation

35
Q

How is endometrial carcinoma staged?

A

Stages I-IV

36
Q

What does prognosis of endometrial carcinoma depend on?

A

Stage

Histological grade

Depth of myometrial invasion

37
Q

What is the treatment for endometrial carcinoma?

A

Hysterectomy; chemo/radiotherapy

38
Q

How are endometroid carcionomas primarily graded?

A

By their architecture;

Grade 1: 5% or less solid growth

Grade 2: 6-50% solid growth

Grade 3: > 50% solid growth

39
Q

Stage I endometrial cancers are confined to the

A

Uterus

40
Q

What endometrial cancer arises from stroma?

A

Endometrial stromal sarcoma

41
Q

Which endometrial cancer is a mixed tumour with malignant epithelial and stromal elements?

A

Carcinosarcoma

42
Q

Describe endometrial stromal sarcoma?

A

Rare, cells resemble endometrial stroma

Infiltrate myometrium and often lymphovascular spaces

43
Q

How does endometrial stromal sarcoma present?

A

AUB but initial presentation may be metastases- most commonly lung or ovary

44
Q

Carcinomasarcomas are responsible for <_% of uterine malignancies

A

<5%

45
Q

What is seen in 50% of carcinosarcoma cases?

A

Heterologous elements- rhabdomyosarcoma, chondrosarcoma, osteosarcoma

46
Q

What conveys the worst prognosis in carcinosarcoma?

A

Presence of rhabdomyosarcomatous component

47
Q

Which tumour commonly protrudes through the cervical canal?

A

Carcinosarcoma

48
Q

What are the smooth muscle tumours of the myometrium?

A

Leiomyoma (fibroid);

Very common

Associated with menorrhagia, infertility

Leiomyosarcoma (rare)

49
Q

Describe a leiomyosarcoma?

A

Malignant smooth muscle tumour commonly displaying a spindle cell morphology

50
Q

What is the commonest uterine sarcoma?

A

Leiomyosarcoma

51
Q

Leiomyosarcoma accounts for _-_% of all uterine malignancies

Most occur in women > __ years

Overall 5 year survival rates __-__%

A

Leiomyosarcoma accounts for 1-2% of all uterine malignancies

Most occur in women > 50 years

Overall 5 year survival rates 15-25%

52
Q

What are the commonest symptoms of leiomyosarcoma?

A

Abnormal vaginal bleeding, palpable pelvic mass and pelvic pain

53
Q

What do leiomyosarcoma and endometrial stromal sarcoma share?

A

A scoring system

Reproductive & Sexual Health (54 decks)

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