Uterine Malignancy Flashcards
When do endometrial polyps occur?
Around or after the menopause
What are the types of endometrial hyperplasia?
And their associations with cancer?
Simple - no increased incidence of cancer
Complex
Atypical - precursor of cancer
What is the distribution of simple endometrial hyperplasia compared to complex or atypical?
Simple - general (i.e. whole endometrium)
Complex/ Atypical - focal
What is the peak incidence for endometrial carcinoma?
Menopausal - 50-60 years
Especially if obese
If a young woman presents with endometrial carcinoma, what diagnosis must be considered?
PCOS
Lynch syndrome
What is Lynch syndrome?
Hereditary nonpolyposis colorectal cancer
Colon, endometrial, ovary, stomach, small intestime etc
What are the two types of endometrial carcinomas?
Type 1 - endometrioid carcinoma and mucinous carcinoma (80%)
Type 2 - serous and clear cell carcinoma (more aggressive)
What is the precursor of type 1 endometrioid carcinoma?
Atypical hyperplasia
What is the precursor of type 2 serous carcinoma?
Serous intraepithelial carcinoma
How does endometrial carcinoma usually present?
Abnormal bleeding
Post-menopausal
What is the microscopic appearance of endometrial carcinoma?
Adenocarcinomas
Glandular
Well differentiated
Which gene is implicated in serous/ clear cell type 2 endometrial carcinomas?
TP53
What type of mutation is associated with type 1 endometrial cancers?
Microsatellite instability
Germline mutation of mismatch repair genes
Why is obesity associated with endometrial cancer?
Too many adipocytes
Androgens converted into oestrogens
Which induce endometrial proliferation
Treatment of endometrial type 1 cancer?
Hysterectomy - but many of these woman are too large for surgery
Treatment of endometrial type 2 cancer?
More extensive than type 1 because it is a more aggressive cancer
Surgery - remove pelvic lymph nodes
Chemo and radio
How does endometrial carcinoma tend to spread?
Directly into myometrium first then into cervix
Lymphatic
Haematogenous
How is endometrioid carcinoma graded?
Grade 1 - 5% or less solid growth
Grade 2 - 6-50% solid growth
Grade 3 - >50% solid growth of sheets (poorly differentiated)
Why are serous carcinoma and clear cell carinoma of endometrium not formally graded?
Highly aggressive and already poorly differentiaed
How is endometrial cancer staged?
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
What is a carcinosarcoma of endometrium?
Rare high grade tumour with carcinomatous and sarcomatous elements
