Uterine Malignancy

Question 1

When do endometrial polyps occur?

Answer 1

Around or after the menopause

Question 2

What are the types of endometrial hyperplasia?

And their associations with cancer?

Answer 2

Simple - no increased incidence of cancer
Complex
Atypical - precursor of cancer

Question 3

What is the distribution of simple endometrial hyperplasia compared to complex or atypical?

Answer 3

Simple - general (i.e. whole endometrium)

Complex/ Atypical - focal

Question 4

What is the peak incidence for endometrial carcinoma?

Answer 4

Menopausal - 50-60 years

Especially if obese

Question 5

If a young woman presents with endometrial carcinoma, what diagnosis must be considered?

Answer 5

PCOS

Lynch syndrome

Question 6

What is Lynch syndrome?

Answer 6

Hereditary nonpolyposis colorectal cancer

Colon, endometrial, ovary, stomach, small intestime etc

Question 7

What are the two types of endometrial carcinomas?

Answer 7

Type 1 - endometrioid carcinoma and mucinous carcinoma (80%)
Type 2 - serous and clear cell carcinoma (more aggressive)

Question 8

What is the precursor of type 1 endometrioid carcinoma?

Answer 8

Atypical hyperplasia

Question 9

What is the precursor of type 2 serous carcinoma?

Answer 9

Serous intraepithelial carcinoma

Question 10

How does endometrial carcinoma usually present?

Answer 10

Abnormal bleeding

Post-menopausal

Question 11

What is the microscopic appearance of endometrial carcinoma?

Answer 11

Adenocarcinomas
Glandular
Well differentiated

Question 12

Which gene is implicated in serous/ clear cell type 2 endometrial carcinomas?

Answer 12

TP53

Question 13

What type of mutation is associated with type 1 endometrial cancers?

Answer 13

Microsatellite instability

Germline mutation of mismatch repair genes

Question 14

Why is obesity associated with endometrial cancer?

Answer 14

Too many adipocytes
Androgens converted into oestrogens
Which induce endometrial proliferation

Question 15

Treatment of endometrial type 1 cancer?

Answer 15

Hysterectomy - but many of these woman are too large for surgery

Question 16

Treatment of endometrial type 2 cancer?

Answer 16

More extensive than type 1 because it is a more aggressive cancer
Surgery - remove pelvic lymph nodes
Chemo and radio

Question 17

How does endometrial carcinoma tend to spread?

Answer 17

Directly into myometrium first then into cervix
Lymphatic
Haematogenous

Question 18

How is endometrioid carcinoma graded?

Answer 18

Grade 1 - 5% or less solid growth
Grade 2 - 6-50% solid growth
Grade 3 - >50% solid growth of sheets (poorly differentiated)

Question 19

Why are serous carcinoma and clear cell carinoma of endometrium not formally graded?

Answer 19

Highly aggressive and already poorly differentiaed

Question 20

How is endometrial cancer staged?

Answer 20

Stage I - confined to uterus
Stage 2 - invades cervical stroma
Stage 3 - local and regional spread
Stage 4 - tumour invades bladder and/or bowel mucosa and/or distant metastases

Question 21

What is a carcinosarcoma of endometrium?

Answer 21

Rare high grade tumour with carcinomatous and sarcomatous elements