Uterine Malignancy

Question 1

when do endometrial polyps tend to occur?

Answer 1

around/after menopause

Question 2

name the categories of endometrial hyperplasia; what category is premalignant?

Answer 2

simple
complex
atypical - premalignant

Question 3

what is endometrial hyperplasia?

Answer 3

an increase in the number of endometrial glands

Question 4

cause of EH?

Answer 4

unknown but may be endometrial hyperplasia

Question 5

presentation of EH?

Answer 5

abnormal bleeding (eg DUB or postmenopausal bleeding)

Question 6

what does a biopsy of simple EH look like? is cytology normal or abnormal?

Answer 6

general distrubution with hyperplasia of glands and stroma but cytology is normal

Question 7

what is the difference between complex and simple EH?

Answer 7

focal rather than general distribution

glands are crowded

Question 8

Tx of EH?

Answer 8

give progesterone to stop the endometrium from proliferating eg through coil

Question 9

a cancer in stroma is called a….

Answer 9

sarcoma

Question 10

what should glands look like on a biopsy in normal endometrium?

Answer 10

circular

Question 11

“cigar shaped nuclei”

Answer 11

complex endothelial hyperplasia

Question 12

Tx of complex atypical hyperplasia?

Answer 12

hysterectomy

Question 13

how are biopsies of the endometrium typically taken?

Answer 13

pipelle biopsy

Question 14

if a woman under 40 gets endometrial cancer, what should you consider?

Answer 14

underlying genetic predisposition
PCOS
lynch syndrome

Question 15

lynch syndrome puts you at high risk of what cancers?

Answer 15

endometrial carcinoma

colorectal cancer

Question 16

precursor pathology to serous carcinoma (form of endometrial cancer)?

Answer 16

serous intraepithelial carcinoma

Question 17

endometrial carcinomas are usually what kind of cancer?

Answer 17

adenocarinoma

Question 18

what does the uterus look like macroscopically in endometrial carcinoma?

Answer 18

large uterus

polypoid

Question 19

what kind of endometrial carcinoma is most common? what is its precursor pathology?

Answer 19

endometrioid

atypical endometrial hyperplasia

Question 20

who gets serous/clear cell carcinoma?

Answer 20

elderly post menopausal women (those with thin, atrophic endometriums)

Question 21

if this structure is affected in an endometrial tumour, it is malignant…

Answer 21

myometrium

Question 22

why can obesity cause endometrial cancer?

Answer 22

1. adipocytes convert ovarian androgens into oestrogens which proliferates the endometrium
2. free insulin eg from insulin resistance can cause proliferation of endometrium

Question 23

lynch syndrome inheritance?

Answer 23

AD

Question 24

Ix lynch syndrome?

Answer 24

immunohistochemistry staining for mismatch repair proteins

Question 25

main mutation in serous carcinoma?

Answer 25

TP53

Question 26

which is more severe: endometrioid or serous carcinoma?

Answer 26

serous

Question 27

where does serous carcinoma tend to spread to?

Answer 27

fallopian tubes

peritoneum

Question 28

Tx endometrial carcinoma

Answer 28

hysterectomy

chemo/radio

Question 29

serous carcinomas are not graded T or F

Answer 29

T, always aggressive so would always be grade 3 anyway

Question 30

what is a carcinosarcoma?

Answer 30

a mix of malignant epithelial and stromal elements of the endometrium

Question 31

presentation of endometrial stromal sarcoma?

Answer 31

abnormal uterine bleeding

metastatic symptoms eg ovary/lung

Question 32

Tx of endometrial stromal sarcoma?

Answer 32

anti-oestrogens

Question 33

histological appearance of ESS?

Answer 33

stroma present in the myometrium (smooth muscle with stromal invasion)

Question 34

carcinosarcoma can present with what abnormal cells in the endometrium?

Answer 34

rhabdomyosarcomatous cells
chondromyosarcomatous cell
osteosaromatous cell

Question 35

another word for leiomyoma?

Answer 35

fibroids

Question 36

most common uterine sarcoma?

Answer 36

leimyosarcoma

Question 37

who gets leiomyosarcoma?

Answer 37

women >50

Question 38

presentation of leimyosarcoma?

Answer 38

abnormal bleeding
palpable pelvic mass
pelvic pain

Question 39

prognosis of leiomyosarcoma?

Answer 39

BAD (5yr = 15-25%)

Question 40

endometrial cancer commonly involves metaplasia of what to what?

Answer 40

glandular epithelium to squamous epithelium

Question 41

why is operating on obese patients a problem?

Answer 41

higher chance of sleep apnoea
problems with intubation
problems with IV access
VTE risk

Question 42

why is chemotherapy often used with radiotherapy

Answer 42

chemo can sensitise cancers

Question 43

when would you use radiotherapy in addition to a hysterectomy for EC?

Answer 43

vascular invasion

lymph node involvement

Question 44

side effects of pelvic radiotherapy?

Answer 44

skin reactions
bladder inflammation - cystitis/polyuria/dysuria
rectal irritation - diarrhoea/PR bleeding

Question 45

what cancers can be caused by radiotherapy

Answer 45

angiosarcoma

Question 46

what is desmoplasia?

Answer 46

spindly, abnormal stroma

Question 47

what does the transformation zone look like histologically?

Answer 47

squamous overlying glandular epithelium

Question 48

what is the ectropion

Answer 48

exposed glandular epithelium that extends out of the external os in reproductive age women

Question 49

when would you do a PET in staging?

Answer 49

if you’re looking for something suspicious

Question 50

what would determine whether you do hysterectomy + nodes or chemo/radio?

Answer 50

if lymph nodes are involved or margins are affected

Question 51

your Hb must be over 10 before getting radiotherapy

Answer 51

10

Question 52

cisplatin causes hair loss T or F

Answer 52

F