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Reproduction and Sexual Health > Uterine Malignancy > Flashcards

Uterine Malignancy Flashcards

1
Q

What are the 2 non-cancerous causes of dysfunctional uterine bleeding?

A
  • Endometrial polyps

* Endometrial hyperplasia

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2
Q

Endometrial polyps are rare

A

FALSE- they are very common

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3
Q

When, in a woman’s life, are polyps most common?

A

Occur around the time of menopause and after menopause

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4
Q

What are the 3 different categories of endometrial hyperplasia?

A
  • Simple
  • Complex
  • Atypical (precursor of carcinoma)
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5
Q

What is the cause of endometrial hyperplasia?

A

Cause is often unknown, but may be due to persistent oestrogen stimulation

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6
Q

Describe simple endometrial hyperplasia.

A

General which affects the entire endometrium, as they glands grow they become cystic

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7
Q

Describe complex endometrial hyperplasia

A

Usually focal and only affects part of the endometrium

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8
Q

If cells of endometrial hyperplasia are atypical, what can they also be said to be?

A

Complex + pre malignant

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9
Q

Why can hyperplasia look like ‘swiss cheese’ on histology?

A

Due to lots of cystic dilatations

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10
Q

In simple hyperplasia glands are cystically dilated because they continue to grow, why is this?

A

Common around the time on the menopause, if a woman doesn’t ovulate every months, she contines to secrete low levels of oestrogen which causes these glands to grow

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11
Q

Describe the histological appearance of complex atypical hyperplasia.

A

Glands are crowded

Cytology is atypical – cells are round instead of cigar-shaped, and they lose polarity in that nuclei don’t sit on the BM, but are higher up in the cells

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12
Q

When is the peak incidence of endometrial carcinoma?

A

Peak incidence in 50-60 year olds, uncommon in anyone under 40

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13
Q

Under what age is endometrial carcinoma uncommon?

A

Under 40 years

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14
Q

In a young woman (under 40 years) with endometrial carcinoma, what should you consider?

A

In young women, consider underlying predisposition e.g. polycystic ovary syndrome or Lynch syndrome

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15
Q

What are the 2 main groups of precursor lesions for endometrial carcinoma?

A
  • Endometrioid carcinoma – precursor atypical hyperplasia

* Serous carcinoma – precursor serous intraepithelial carcinoma

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16
Q

How does endometrial cancer present?

A

Abnormal bleeding

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17
Q

Describe the macroscopic appearance of endometrial cancer.

A
  • Large uterus

* Polypoid

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18
Q

Describe the microscopic appearance of endometrial cancer.

A
  • Most are adenocarcinomas

* Most are well differentiated

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19
Q

Describe the spread of endometrial cancer.

A
  • Directly into myometrium and cervix
  • Lymphatic
  • Haemotogenous
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20
Q

What are the 2 main clinical types of endometrial cancer.

A
  1. Endometrioid and Mucinous

2. Serous and Clear cell

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21
Q

What % of all endometrial cancers does ‘endometriosis and mucinous’ account for?

A

80%

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22
Q

What are ‘endometriosis and mucinous’ endometrial cancers related to?

A

Unopposed oestrogen

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23
Q

‘endometriosis and mucinous’ endometrial cancers are associated with ….

A

Endometrial hyperplasia

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24
Q

List 3 common gene mutations found in patients with ‘endometriosis and mucinous’ endometrial cancers?

A
  1. PTEN
  2. KRAS
  3. PIK3CA
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25
Q

Microsatellite instability is seen histologically in which cancer?

A

‘endometriosis and mucinous’ endometrial cancers

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26
Q

Who does serous and clear cell endometrial cancer affect?

A

Affect elderly post‐menopausal women

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27
Q

What type of endometrial cancer is very rare?

A

Clear cell

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28
Q

What gene mutation is often found in women with serous and clear cell endometrial cancer?

A

TP53 often mutated

29
Q

Describe the spread of serous and clear cell endometrial cancer?

A

Spreads along Fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease  can spread to peritoneal cavity

30
Q

Describe the spread of serous and clear cell endometrial cancer?

A

Spreads along Fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease

Can spread to peritoneal cavity !!

31
Q

Serous and clear cell endometrial cancer is more aggressive than endometrioid

32
Q

Precursor lesion  serous endometrial intraepithelial carcinoma

A

Serous and Clear Cell

33
Q

Outline the treatment for endometrial cancer.

A

Surgery – more extensive
+
Chemo/Radiotherapy

34
Q

‘A complex papillary +/or glandular architecture with diffuse, marked nuclear pleomorphism’. What does this describe?

A

Serous carcinoma

35
Q

Obesity is a known risk factor for ___________ cancer

A

Endometrial

36
Q

Why does being obese increase your risk of endometrial cancer?

A

This excess risk is associated with the endocrine and inflammatory effects of adipose tissue

Adipocytes express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation

37
Q

What do adiopocytes express?

38
Q

What does aromatase do?

A

Converts androgens to oestrogen

39
Q

Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher

40
Q

Insulin action is altered in obese women. Explain this.

A
  • Level of insulin-binding globulins is reduced
  • Free insulin levels are elevated
  • Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium
41
Q

What is Lynch syndrome?

A

Hereditary non-polyposis colorectal cancer i.e a cancer predisposition syndrome

42
Q

What are women with Lynch syndrome more likely to present with?

A

Endometrial cancer

43
Q

Having Lynch syndrome puts you at an increased risk of what cancers?

A
  • Colorectal cancer
  • Endometrial cancer
  • Ovarian cancer (increased risk)
44
Q

Why does Lynch syndrome increase your risk of cancer?

A

Due to the inheritance of a defective DNA mismatch repair gene

45
Q

What is the inheritance pattern of Lynch syndrome?

A

Autosomal dominant

46
Q

How is Lynch syndrome diagnosed?

A

Testing cancer tissue for MSI (microsatellite instability)

47
Q

What is MSI?

A
  • A characteristic of defective mismatch repair

* Shown by Lynch cell tumours

48
Q

Where does endometrial carcinoma typically infiltrate?

A

Myometrium

49
Q

Outline the grading of endometrioid carcinoma.

A
  • Grade 1 – 5% or less solid growth
  • Grade 2 – 6-50% solid growth
  • Grade 3 - >50% solid growth
50
Q

What is a carcinosarcoma?

A

A mixed tumour with malignant epithelial and stromal elements

51
Q

What is a carcinosarcoma also known as?

A

Malignant mixed Mullerian tumour

52
Q

What is the prognosis of a carcinosarcoma like?

53
Q

What is the presentation of an endometrial stromal sarcoma?

A

Abnormal uterine bleeding

54
Q

Where does an endometrial stromal sarcoma usually met to?

A

Ovary or lung

55
Q

Where does an endometrial stromal sarcoma usually met to?

A

Ovary or lung

56
Q

Where do endometrial stromal sarcomas usually infiltrate?

A

Infiltrate myometrium and often lymphovascular spaces

57
Q

Describe a high grade endometrial stromal sarcoma.

A

It had increased atypia and proliferative activity - more serious

58
Q

What % of all uterine malignancies does a carcinosarcoma account for?

59
Q

What do 50% of carcinosarcomas have?

A

Heterologous elements – rhabdomyosarcoma, chrondrosarcoma, osteosarcoma

60
Q

The carcinosarcomas with the worst prognosis are the ones with?

A

Rhabdomyosarcomatous component

61
Q

Name the 2 types of myocetrial (smooth muscle) tumour of the uterus.

A
  • Leiomyoma (fibroids)

* Leiomyosarcoma (rare)

62
Q

Name the 2 types of myometrial (smooth muscle) tumour of the uterus.

A
  • Leiomyoma (fibroids)

* Leiomyosarcoma (rare)

63
Q

Menorrhagia + Infertility is associated with?

A

Myometrial pathology

64
Q

What is a Leiomyosarcoma?

A

A malignant smooth muscle tumour, commonly displaying a spindle cell morphology

65
Q

The most common uterine sarcoma is a?

A

Leiomyosarcoma

66
Q

What women get Leiomyosarcoma?

A

Women over 50 years

67
Q

What are the symptoms of a Leiomyosarcoma?

A
  • Abnormal vaginal bleeding
  • Palpable pelvic mass
  • Pelvic pain
68
Q

What is the prognosis of a Leiomyosarcoma like?

A

POOR prognosis even if this is confined to the uterus

Reproduction and Sexual Health (51 decks)

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