Uterine Malignancy Flashcards
when do endometrial polyps tend to occur?
around/after menopause
name the categories of endometrial hyperplasia; what category is premalignant?
simple
complex
atypical - premalignant
what is endometrial hyperplasia?
an increase in the number of endometrial glands
cause of EH?
unknown but may be endometrial hyperplasia
presentation of EH?
abnormal bleeding (eg DUB or postmenopausal bleeding)
what does a biopsy of simple EH look like? is cytology normal or abnormal?
general distrubution with hyperplasia of glands and stroma but cytology is normal
what is the difference between complex and simple EH?
focal rather than general distribution
glands are crowded
Tx of EH?
give progesterone to stop the endometrium from proliferating eg through coil
a cancer in stroma is called a….
sarcoma
what should glands look like on a biopsy in normal endometrium?
circular
“cigar shaped nuclei”
complex endothelial hyperplasia
Tx of complex atypical hyperplasia?
hysterectomy
how are biopsies of the endometrium typically taken?
pipelle biopsy
if a woman under 40 gets endometrial cancer, what should you consider?
underlying genetic predisposition
PCOS
lynch syndrome
lynch syndrome puts you at high risk of what cancers?
endometrial carcinoma
colorectal cancer
precursor pathology to serous carcinoma (form of endometrial cancer)?
serous intraepithelial carcinoma
endometrial carcinomas are usually what kind of cancer?
adenocarinoma
what does the uterus look like macroscopically in endometrial carcinoma?
large uterus
polypoid
what kind of endometrial carcinoma is most common? what is its precursor pathology?
endometrioid
atypical endometrial hyperplasia
who gets serous/clear cell carcinoma?
elderly post menopausal women (those with thin, atrophic endometriums)
if this structure is affected in an endometrial tumour, it is malignant…
myometrium
why can obesity cause endometrial cancer?
- adipocytes convert ovarian androgens into oestrogens which proliferates the endometrium
- free insulin eg from insulin resistance can cause proliferation of endometrium
lynch syndrome inheritance?
AD
Ix lynch syndrome?
immunohistochemistry staining for mismatch repair proteins
main mutation in serous carcinoma?
TP53
which is more severe: endometrioid or serous carcinoma?
serous
where does serous carcinoma tend to spread to?
fallopian tubes
peritoneum
Tx endometrial carcinoma
hysterectomy
chemo/radio
serous carcinomas are not graded T or F
T, always aggressive so would always be grade 3 anyway
what is a carcinosarcoma?
a mix of malignant epithelial and stromal elements of the endometrium
presentation of endometrial stromal sarcoma?
abnormal uterine bleeding
metastatic symptoms eg ovary/lung
Tx of endometrial stromal sarcoma?
anti-oestrogens
histological appearance of ESS?
stroma present in the myometrium (smooth muscle with stromal invasion)
carcinosarcoma can present with what abnormal cells in the endometrium?
rhabdomyosarcomatous cells
chondromyosarcomatous cell
osteosaromatous cell
another word for leiomyoma?
fibroids
most common uterine sarcoma?
leimyosarcoma
who gets leiomyosarcoma?
women >50
presentation of leimyosarcoma?
abnormal bleeding
palpable pelvic mass
pelvic pain
prognosis of leiomyosarcoma?
BAD (5yr = 15-25%)
endometrial cancer commonly involves metaplasia of what to what?
glandular epithelium to squamous epithelium
why is operating on obese patients a problem?
higher chance of sleep apnoea
problems with intubation
problems with IV access
VTE risk
why is chemotherapy often used with radiotherapy
chemo can sensitise cancers
when would you use radiotherapy in addition to a hysterectomy for EC?
vascular invasion
lymph node involvement
side effects of pelvic radiotherapy?
skin reactions
bladder inflammation - cystitis/polyuria/dysuria
rectal irritation - diarrhoea/PR bleeding
what cancers can be caused by radiotherapy
angiosarcoma
what is desmoplasia?
spindly, abnormal stroma
what does the transformation zone look like histologically?
squamous overlying glandular epithelium
what is the ectropion
exposed glandular epithelium that extends out of the external os in reproductive age women
when would you do a PET in staging?
if you’re looking for something suspicious
what would determine whether you do hysterectomy + nodes or chemo/radio?
if lymph nodes are involved or margins are affected
your Hb must be over 10 before getting radiotherapy
10
cisplatin causes hair loss T or F
F
