Uterine Malignancy

Question 1

what causes dysfunctional uterine bleeding

Answer 1

endometrial polyps (overgrowth of endometrium)

endometrial hyperplasia (simple, complex, atypical)

Question 2

what is simple endometrial hyperplasia

Answer 2

general distribution

increase in volume of stroma and glands

normal cytology

dilated but not crowded

Question 3

what is complex endometrial hyperplasia

Answer 3

focal distribution

glands increase in volume

crowded glands

abnormal cytology

Question 4

what is atypical endometrial hyperplasia

Answer 4

focal distribution

increase in glands volume

crowded glands

atypical cytology

Question 5

what causes endometrial hyperplasia

Answer 5

often unknown, may be persistent oestrogen stimulation

presents with abnormal bleeding

Question 6

peak incidence of endometrial cancer

Answer 6

50-60 years (uncommon under 40)

Question 7

what underlying predispositions might young women with endometrial cancer have

Answer 7

polycystic ovary syndrome

Lynch syndrome

Question 8

what is the most common type of endometrial cancer

Answer 8

endometriod carcinoma (graded 1,2 or 3)

(mucinous- adenocarcinoma)

(atypical hyperplasia is precursor)

Question 9

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

Answer 9

serous carcinoma (clear cell)

precursor is serous intraepithelial carcinoma

Question 10

how does endometrial cancer usually present

Answer 10

with abnormal bleeding

Question 11

what does endometrial cancer look like to naked eye

Answer 11

large uterus

polypoid

Question 12

what does endometrial cancer look like microscopically

Answer 12

most are adenocarcinomas

most are well differentiated

Question 13

where do endometrial carcinoma spread

Answer 13

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

lymphatic

haematogenous

Question 14

what is a type 1 endometrial carcinoma

Answer 14

endometriod carcinoma (adenocarcinoma)

Question 15

what is at type 2 endometrial tumour

Answer 15

serous carcinoma (and clear cell)

Question 16

what is a big risk factor for endometrial cancer

Answer 16

obesity

associated with endocrine and inflammatory effects of endocrine tissue

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

Question 17

what is Lynch syndrome

Answer 17

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

inheritance of defective DNA mismatch repair gene

Question 18

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

Answer 18

characteristic of defective mismatch repair

micro satellite instability

Question 19

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

Answer 19

intraepithelial carcinoma

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

Question 20

what endometrial cancer is most aggressive

Answer 20

type II endometrial carcinomas (serous and clear cell)

Question 21

what sign in histology identities clear cell carcinoma

Answer 21

‘hobnail change?”

Question 22

what sign in histology suggest serous carcinoma

Answer 22

inflammation

jaggy?

Question 23

where can serous carcinoma spread to early

Answer 23

peritoneal cavity

Question 24

prognosis for endometrioid carcinoma

Answer 24

good - usually confined to uterus at presentation

Question 25

how are endometriod carcinoma graded

Answer 25

grades 1-3 grade 3 is the most aggressive

Question 26

how are endometrial tumours staged

Answer 26

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

Question 27

what are the other less common endometrial tumours

Answer 27

Endometrial stroma sarcoma (from endometrial stoma) Carcinosarcoma (mixed tumour with malignant epithelial and stomal elements)

Question 28

how do endometrial stroma sarcoma present

Answer 28

v rare present with abnormal uterine bleeding or initially can present with metastases

Question 29

characteristics of carcinosarcoma

Answer 29

combination of stromal and malignant epithelial cells <5% of uterine malignancies heterologous elements commonly seen in 50% of cases rhabdomyosarcomatous component worsens the prognosis

Question 30

what tumours can you get in the myometrium

Answer 30

Leiomyoma (fibroid) - v common - associated with menorrhagia, infertility Leiomyosarcoma (rare)

Question 31

characteristics of leiomyosarcoma

Answer 31

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