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3 Reproduction > Uterine Malignancy > Flashcards

Uterine Malignancy Flashcards

1
Q

what causes dysfunctional uterine bleeding

A

endometrial polyps (overgrowth of endometrium)

endometrial hyperplasia (simple, complex, atypical)

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2
Q

what is simple endometrial hyperplasia

A

general distribution

increase in volume of stroma and glands

normal cytology

dilated but not crowded

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3
Q

what is complex endometrial hyperplasia

A

focal distribution

glands increase in volume

crowded glands

abnormal cytology

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4
Q

what is atypical endometrial hyperplasia

A

focal distribution

increase in glands volume

crowded glands

atypical cytology

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5
Q

what causes endometrial hyperplasia

A

often unknown, may be persistent oestrogen stimulation

presents with abnormal bleeding

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6
Q

peak incidence of endometrial cancer

A

50-60 years (uncommon under 40)

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7
Q

what underlying predispositions might young women with endometrial cancer have

A

polycystic ovary syndrome

Lynch syndrome

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8
Q

what is the most common type of endometrial cancer

A

endometriod carcinoma (graded 1,2 or 3)

(mucinous- adenocarcinoma)

(atypical hyperplasia is precursor)

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9
Q

what endometrial tumours effect post-menopausal elderly women with TP53 mutations

A

serous carcinoma (clear cell)

precursor is serous intraepithelial carcinoma

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10
Q

how does endometrial cancer usually present

A

with abnormal bleeding

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11
Q

what does endometrial cancer look like to naked eye

A

large uterus

polypoid

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12
Q

what does endometrial cancer look like microscopically

A

most are adenocarcinomas

most are well differentiated

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13
Q

where do endometrial carcinoma spread

A

into myometrium and cervix (when it goes into the cervix it becomes stage 2)

lymphatic

haematogenous

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14
Q

what is a type 1 endometrial carcinoma

A

endometriod carcinoma (adenocarcinoma)

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15
Q

what is at type 2 endometrial tumour

A

serous carcinoma (and clear cell)

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16
Q

what is a big risk factor for endometrial cancer

A

obesity

associated with endocrine and inflammatory effects of endocrine tissue

adipose cells secrete aromatase that converts ovarian androgens into oestrogen’s inducing endometrial proliferations

17
Q

what is Lynch syndrome

A

cancer predisposition syndrome - high risk of colorectal cancer and endometrial cancer

inheritance of defective DNA mismatch repair gene

18
Q

how can you tell if a tumour is a Lynch syndrome tissue

A

characteristic of defective mismatch repair

micro satellite instability

19
Q

what is the precursor region for type II serous and clear cell endometrial carcinomas

A

intraepithelial carcinoma

-not broken basement membrane but v aggressive - spreads along Fallopian tubes mucosa and peritoneal surfaces so can present with extrauterine disease

20
Q

what endometrial cancer is most aggressive

A

type II endometrial carcinomas (serous and clear cell)

21
Q

what sign in histology identities clear cell carcinoma

A

‘hobnail change?”

22
Q

what sign in histology suggest serous carcinoma

A

inflammation

jaggy?

23
Q

where can serous carcinoma spread to early

A

peritoneal cavity

24
Q

prognosis for endometrioid carcinoma

A

good - usually confined to uterus at presentation

25
Q

how are endometriod carcinoma graded

A

grades 1-3

grade 3 is the most aggressive

26
Q

how are endometrial tumours staged

A

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

27
Q

what are the other less common endometrial tumours

A

Endometrial stroma sarcoma
(from endometrial stoma)

Carcinosarcoma (mixed tumour with malignant epithelial and stomal elements)

28
Q

how do endometrial stroma sarcoma present

A

v rare

present with abnormal uterine bleeding or initially can present with metastases

29
Q

characteristics of carcinosarcoma

A

combination of stromal and malignant epithelial cells

<5% of uterine malignancies

heterologous elements commonly seen in 50% of cases

rhabdomyosarcomatous component worsens the prognosis

30
Q

what tumours can you get in the myometrium

A

Leiomyoma (fibroid)

  • v common
  • associated with menorrhagia, infertility

Leiomyosarcoma (rare)

31
Q

characteristics of leiomyosarcoma

A

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

3 Reproduction (49 decks)

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