Uterine Malignancy Flashcards
what causes dysfunctional uterine bleeding
endometrial polyps (overgrowth of endometrium)
endometrial hyperplasia (simple, complex, atypical)
what is simple endometrial hyperplasia
general distribution
increase in volume of stroma and glands
normal cytology
dilated but not crowded
what is complex endometrial hyperplasia
focal distribution
glands increase in volume
crowded glands
abnormal cytology
what is atypical endometrial hyperplasia
focal distribution
increase in glands volume
crowded glands
atypical cytology
what causes endometrial hyperplasia
often unknown, may be persistent oestrogen stimulation
presents with abnormal bleeding
peak incidence of endometrial cancer
50-60 years (uncommon under 40)
what underlying predispositions might young women with endometrial cancer have
polycystic ovary syndrome
Lynch syndrome
what is the most common type of endometrial cancer
endometriod carcinoma (graded 1,2 or 3)
(mucinous- adenocarcinoma)
(atypical hyperplasia is precursor)
what endometrial tumours effect post-menopausal elderly women with TP53 mutations
serous carcinoma (clear cell)
precursor is serous intraepithelial carcinoma
how does endometrial cancer usually present
with abnormal bleeding
what does endometrial cancer look like to naked eye
large uterus
polypoid
what does endometrial cancer look like microscopically
most are adenocarcinomas
most are well differentiated
where do endometrial carcinoma spread
into myometrium and cervix (when it goes into the cervix it becomes stage 2)
lymphatic
haematogenous
what is a type 1 endometrial carcinoma
endometriod carcinoma (adenocarcinoma)
what is at type 2 endometrial tumour
serous carcinoma (and clear cell)
what is a big risk factor for endometrial cancer
obesity
associated with endocrine and inflammatory effects of endocrine tissue
adipose cells secrete aromatase that converts ovarian androgens into oestrogen’s inducing endometrial proliferations
what is Lynch syndrome
cancer predisposition syndrome - high risk of colorectal cancer and endometrial cancer
inheritance of defective DNA mismatch repair gene
how can you tell if a tumour is a Lynch syndrome tissue
characteristic of defective mismatch repair
micro satellite instability
what is the precursor region for type II serous and clear cell endometrial carcinomas
intraepithelial carcinoma
-not broken basement membrane but v aggressive - spreads along Fallopian tubes mucosa and peritoneal surfaces so can present with extrauterine disease
what endometrial cancer is most aggressive
type II endometrial carcinomas (serous and clear cell)
what sign in histology identities clear cell carcinoma
‘hobnail change?”
what sign in histology suggest serous carcinoma
inflammation
jaggy?
where can serous carcinoma spread to early
peritoneal cavity
prognosis for endometrioid carcinoma
good - usually confined to uterus at presentation
how are endometriod carcinoma graded
grades 1-3
grade 3 is the most aggressive
how are endometrial tumours staged
stage 1- confined to uterus
stage 2- invades cervix
stage 3- local and or regional tumour spread
stage 4- tumour invades bladder and or bowel mucosa
what are the other less common endometrial tumours
Endometrial stroma sarcoma
(from endometrial stoma)
Carcinosarcoma (mixed tumour with malignant epithelial and stomal elements)
how do endometrial stroma sarcoma present
v rare
present with abnormal uterine bleeding or initially can present with metastases
characteristics of carcinosarcoma
combination of stromal and malignant epithelial cells
<5% of uterine malignancies
heterologous elements commonly seen in 50% of cases
rhabdomyosarcomatous component worsens the prognosis
what tumours can you get in the myometrium
Leiomyoma (fibroid)
- v common
- associated with menorrhagia, infertility
Leiomyosarcoma (rare)
characteristics of leiomyosarcoma
malignant smooth muscle tumour
most common uterine sarcoma
1-2% of all uterine malignancies
most occur in women >50 years
poor prognosis even if confined to uterus at time of diagnosis
