uterine cancer

Question 1

typical presentation of uterine cancer?

Answer 1

post-menopausal vaginal bleeding in a woman ae 50-60 years old

Question 2

risk factors for uterine cancer

Answer 2

chronic anovulation (PCOS)
granulosa cell tumour (produces oestrogen)
Lynch syndrome (HNPCC)
unopposed oestrogen (tamoxifen/HRT)
obesity
diabetes

Question 3

why is obesity a risk factor for uterine cancer?

Answer 3

adipocytes contain aromatase which converts peripheral androgens into oestrogen

Question 4

gold standard investigation for uterine cancer?

Answer 4

pelvic (transvaginal) USS

Question 5

indication for a uterine biopsy?

Answer 5

if the endometrium is >4cm thick in a post menopausal woman

Question 6

what are the three types of endometrial hyperplasia?

Answer 6

simple, complex, atypical

Question 7

describe simple endometrial hyperplasia?

Answer 7

dilated glands
diffuse
normal cytology (not pre-malignant)
occurs in PCOS (anovulatory cycles)

Question 8

describe complex endometrial hyperplasia?

Answer 8

FOCAL
crowded rounded glands
normal cytology (not pre-malignant)

Question 9

describe complex atypical endometrial hyperplasia?

Answer 9

FOCAL
crowded glands
atypical cytology
pre malignant

Question 10

what are the two main types of endometrial tumours?

Answer 10

type 1 endometrioid (& mucinous) 80%

type 2 serous (& clear cell)

Question 11

what is the precursor lesion of type 1 endometrioid (& mucinous) tumours?

Answer 11

complex atypical hyperplasia

Question 12

are both type 1 and type 2 tumours graded?

Answer 12

no

type 2 is high grade by nature

Question 13

almost all type 2 serous (& clear cell) tumours have a mutation in which gene?

Answer 13

TP53

Question 14

most common type of uterine tumour

Answer 14

type 1 endometroid adenocarcinoma (well differentiated)

Question 15

type 1/2 tumours are more invasive?

Answer 15

type 2 tumours are less common but more invasive

Question 16

what effect does insulin have on the endometrium?

Answer 16

insulin induces endometrial proliferation

Question 17

what pattern of inheritance is lynch syndrome (HNPCC)

Answer 17

autosomal dominant

Question 18

what feature is the pathologist looking for on a lynch syndrome biopsy?

Answer 18

microsatellite instability

Question 19

which rare uterine tumour has heterologous components and a very poor prognosis?

Answer 19

carcinosarcoma

Question 20

which rare type of ovarian tumour presents late as lung (or ovarian) mets?

Answer 20

endometrial stromal sarcoma

Question 21

when do endometrial polyps typically present?

Answer 21

peri-menopausal age

IMB, menorrhagia, PMB, infertility

Question 22

what is the precursor for type 2 serous (& clear cell) tumours?

Answer 22

serous intraepithelial carcinoma

Question 23

what is the typical pathological finding of leiomyoma (fibroids)?

Answer 23

spindle cell morphology

Question 24

are leiomyoma (fibroids) seen on hysteroscopy?

Answer 24

not unless you perforate the uterus

most leiomyomas are intra/submural