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Reproduction > Uterine Cancer > Flashcards

Uterine Cancer Flashcards

1
Q

What are some causes of dysfunctional uterine bleeding?

A

Endometrial polyps = common, often occur around/after menopause
Endometrial hyperplasia = cause unknown, may be due to persistent oestrogen stimulation

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2
Q

How can endometrial hyperplasia present?

A

Abnormal bleeding = DUB or postmenopausal bleeding

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3
Q

What are the types of endometrial hyperplasia?

A

Simple, complex or atypical (precursor of carcinoma)

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4
Q

What are the features of simple endometrial hyperplasia?

A

General distribution, glands are dilated, affects glands and stroma, normal cytology

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5
Q

What are the features of complex endometrial hyperplasia?

A

Focal distribution, affects glands, normal cytology and crowded glands

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6
Q

What are the features of atypical endometrial hyperplasia?

A

Focal distribution, affects glands, atypical cytology and crowded glands

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7
Q

What is the peak incidence of endometrial carcinoma?

A

Peak incidence in women aged 50-60 = uncommon in women age <40, consider underlying predisposition in young women (e.g PCOS)

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8
Q

What are the two main types of endometrial carcinoma?

A

Endometrioid carcinoma = precursor is atypical hyperplasia

Serous carcinoma = precursor is serous intraepithelial carcinoma

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9
Q

How does endometrial carcinoma present?

A

Usually with abnormal bleeding

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10
Q

What is the appearance of endometrial carcinoma?

A 
Macroscopic = large uterus, polypoid
Microscopic = most are well differentiated and adenocarcinomas
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11
Q

How can endometrial carcinomas spread?

A

Local = directly into myometrium and cervix

Lymphatic and haematogenous spread

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12
Q

What are the most common type of endometrial carcinomas?

A

Endometrioid carcinomas = 80% of tumours

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13
Q

What are some features of endometrioid (type 1) carcinomas?

A

Related to unopposed oestrogen
Endometrioid and mucinous phenotypes
Microsatellite instability = germline mutations of mismatch repair genes (Lynch syndrome)

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14
Q

What mutations are implicated in endometrioid type carcinomas?

A

PTEN, KRAS and PIK3CA mutations

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15
Q

What are some features of serous (type 2) carcinomas?

A

Not associated with unopposed oestrogen
Affect elderly postmenopausal women
Serous and clear cell phenotypes

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16
Q

What mutation is implicated in serous type carcinomas?

A

TP53 mutations and overexpression

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17
Q

How do serous type carcinomas spread?

A

Along fallopian tube mucosa and peritoneal surfaces = able to present as extra-uterine disease

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18
Q

How are serous type carcinomas treated?

A

More aggressive than endometrioid carcinomas = surgery usually more extensive and adjuvant chemo/radiotherapy used more frequently

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19
Q

What characterises serous type carcinomas?

A

Complex papillary and/or glandular architecture with diffuse marked nuclear pleomorphism

20
Q

Where do endometrial carcinomas infiltrate?

A

Typically myometrium

Serous may spread early to peritoneal cavity

21
Q

Why do endometrioid type carcinomas tend to have good prognosis?

A

They tend to stay confined to uterus

22
Q

What does prognosis of endometrial carcinoma depend on?

A

Stage, histological grade and depth of myometrial invasion

23
Q

How is endometrial carcinoma treated?

A

Hysterectomy +/- chemo/radiotherapy

24
Q

What is used to grade endometrial carcinomas?

A

Primarily architecture = serous type isn’t formally graded

25
Q

What are the different grades of endometrial carcinomas?

A

Grade 1 = 5% or less solid growth
Grade 2 = 6-50% solid growth
Grade 3 = >50% solid growth

26
Q

What are stages 1 and 2 of endometrial carcinomas?

A 
1A = no or <50% myometrial invasion
1B = invasion >=50% of myometrium
2 = tumour invades cervical stroma
27
Q

What is stage 3 of endometrial carcinomas?

A 
3A = invades serosa of uterus +/- adnexae
3B = vaginal +/- parametrial involvement
3C = metastases to pelvic +/- para-aortic nodes
28
Q

What is stage 4 endometrial carcinoma?

A

Tumour invades bladder +/- bowel mucosa (4A) +/- distant metastases (4B)

29
Q

Why is obesity a risk factor for endometrial carcinoma?

A

Due to endocrine and inflammatory effects of adipose tissue

30
Q

How do adipocytes cause endometrial carcinoma?

A

Express aromatase that converts ovarian androgens into oestrogens = induces endometrial proliferation

31
Q

What do effects do lower levels of sex hormone-binding globulin in obese women have?

A

They have higher levels of unbound, biologically active hormone

32
Q

What is Lynch syndrome?

A

Hereditary non-polyposis colorectal cancer = cancer predisposition syndrome

33
Q

What cancers do people with Lynch syndrome have a high risk of developing?

A

Colorectal, endometrial and ovarian cancer = tumours show microsatellite instability

34
Q

What causes Lynch syndrome?

A

Inheritance of defective DNA mismatch repair gene = autosomal dominant

35
Q

How can Lynch syndrome be diagnosed?

A

Staining for mismatch repair proteins in tumours

36
Q

What grade are endometrial stromal sarcomas?

A

Either low or high grade (increased atypia, proliferative activity)

37
Q

What are some features of endometrial stromal sarcomas?

A

Rare = arise from endometrial stroma
Cells resemble endometrial stroma
Infiltrate myometrium and often lymphovascular spaces

38
Q

What is the most important prognostic factor for endometrial stromal sarcoma?

A

Stage = high grade more likely to be fatal

39
Q

How doe endometrial stromal sarcomas present?

A

Typically present with abnormal uterine bleeding

Initial presentation may be as metastases = usually ovary or lung

40
Q

What are carcinosarcomas?

A

Mixed tumours with malignant epithelial and stromal elements = account for <5% uterine malignancies

41
Q

What are some features of carcinosarcomas?

A

High grade carcinomatous and sarcomatous elements

Poor prognosis

42
Q

What are some heterologous elements seen in carcinosarcomas?

A

Occur in 50% = rhabdomyosarcoma (worst prognosis), chondrosarcoma, osteosarcoma

43
Q

What are some smooth muscle tumours of the myometrium?

A 
Leiomyoma = fibroid, very common, menorrhagia and infertility
Leiomyosarcoma = rare
44
Q

What is the most common uterine sarcomas?

A

Leiomyosarcoma = accounts for 1-2% of all uterine malignancies, poor prognosis

45
Q

What are some features of leiomyosarcomas?

A

Commonly displays spindle cell morphology
Most common in women aged >50
Shares same staging system as endometrial stromal sarcoma

46
Q

What are some common symptoms of leiomyosarcomas?

A

Abnormal vaginal bleeding, palpable pelvic mass, pelvic pain

47
Q

What is the prognosis of leiomyosarcoma?

A

Overall 5 year survival rate of 15-25% = stage most powerful prognostic factor

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