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Repro and Sexual Health > Uterine Malignancy > Flashcards

Uterine Malignancy Flashcards

1
Q

what can cause disordered uterine bleeding?

A 
endometrial polyps
endometral hyperplasia (simple/complex/atypical)
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2
Q

what are the main things to look for on endometrial biopsy?

A

malignancy
inflammation
presence/absence of hyperplasia

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3
Q

what can cause endometrial hyperplasia?

A

possibly persistent oestrogen stimulation

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4
Q

what categories are used to describe hyperplasia?

A

distribution
component
glands
cytology

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5
Q

features of simple hyperplasia?

A

general distribution
component = glands and stroma
glands = dilated, not crowded
cytology = normal

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6
Q

features of complex hyperplasia?

A

focal distribution
component = glands only
glands = crowded, not round
cytology = normal

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7
Q

features of atypical hyperplasia?

A

focal distribution
component = glands only
glands = more crowded, irregular in shape
cytology = atypical

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8
Q

what change in glands is classed as malignancy?

A

once the glands start to fuse

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9
Q

peak age for endometrial cancer?

A

50-60 yrs

uncommon under 40

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10
Q

what can pedispose to endometrial carcinoma in young women?

A

PCOS

lynch syndrome

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11
Q

2 main groups of endometrial carcinoma with different precursor lesions?

A 
endoemtrioid carcinoma (precursor = atypical hyperplasia)
serous carcinoma (precursor = serous intra-epithelial carcinoma)
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12
Q

how does endometrial carcinoma generally present?

A

abnormal bleeding

- post menopausal

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13
Q

macroscopic features of endometrial carcinoma?

A

large uterus

polypoid

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14
Q

microscopic features of endometrial carcinoma?

A

most are adenocarcinomas

most are well differentiated

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15
Q

how might endometrial carcinoma spread?

A

directly into myometrium and cervix
lymphatic
haematogenous

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16
Q

staging via direct spread?

A

into inner half of myometrium = stage 1A
into outer half of myometrium = 1B
into cervix = stage 2

17
Q

what mutation is typically present in serous (and clear cell) endometrial carcinoma?

A

P53

18
Q

type 1 endometrial carcinoma?

A

endometroid (and mucinous)
- 80% of cancers
related to unopposed oestrogen and associated with atypical hyperpalsia

19
Q

type 2 endometrial carcinomas?

A

serous (and clear cell)

- not associated with unopposed oestrogen and affect elderly post-menopausal women

20
Q

what is type 1 endometrial carcinoma associated with?

A

endometrioid and mucinous phenotypes
PTEN, KRAS and PIK3CA mutations
atypical hyperplasia as precursor lesion
microsatelite instablity (lynch syndrome)

21
Q

name a large risk factor for endometrial cancer and why?

A

obesity

associated with the endocrine and inflammatory effects of adipose tissue

22
Q

how does obesity increase risk of endometrial cancer?

A

adipocytes express aromatase that converts ovarian androgens into oestrogens which induce endometrial proliferation
sex hormone-binding globulin levels are lower in obesity therefore the level of unbound biologically active hormone is lower
lower level of insulin-binding globulins and free insulin levels are elevated (insulin and IGF exert proliferative effect on endometrium)

23
Q

does weight loss affect endometrial cancer risk?

A

yes

reduces it

24
Q

what is lynch syndrome?

A

cancer predisposition syndrome (AKA hereditary non-polyposis colorectal cancer)
causes high risk of colorectal, endometrial and ovarian cancer

25
Q

what causes lynch syndrome?

A

AD inheritance of defective DNA mismatch repair gene

26
Q

features of lynch syndrome tumours?

A

can be identified via immunohistochemistry staining of tumour for mismatch repair proteins
tumours show microsatellite instability (MSI) - a characteristic of defective mismatch repair

27
Q

how do type 2 endometrial carcinomas develop?

A

precursor leison = serous endometrial intraepithelial carcinoma
this spreads along fallopian tube mucosa and peritoneal surfaces so can present with extra-uterine disease

28
Q

how are type 2 endometrial carcinomas managed generally?

A

extensive surgery and adjuvant chemo/radiotherapy

29
Q

histology features of serous?

A

jaggy glands

inflammation

30
Q

histology of clear cell?

A

hobnail changes

31
Q

general prognosis of endometrial carcinoma?

A

depends on stage but generally good

serous invades peritoneal cavity early

32
Q

staging of endometrial carcinoma?

A

depends on histology and depth of invasion
- 1A = none or <50% myometrial invasion
- 1B = 50+% invasion of myometrium
- 2 = tumour invades cervical stroma
- 3 = local/regional tumour spread
- 3A = tumour invades serosa of uterus and/or adnexae
- 3B = vagina and/or parametrial involvement
3C = metastases to pelvic and/or para-aortic lymph nodes
- 4A = invades bladder and/or bowel mucosa
- 4B = distant metastases

33
Q

grading of endometrial carcinoma?

A

grade 1 = 5% or less solid growth, well differentiated
grade 2 = 6-50% solid growth
grade 3 = .50% solid growth, poorly differentiated
(serous and clear cell generally not graded)

34
Q

what other endometrial tumours can occur?

A

endometrial stromal sarcoma (arises from endometrial stroma)
carcinosarcoma (mixed with malignant epithelial and stromal elements)
used to be called malignant mixed mullerian tumour

35
Q

describe endometrial stromal sarcoma?

A

can be low or high grade
cells resemble endometrial stroma
infiltrate myometrium and often the lymphovascular spaces
typically presents with abnormal uterine bleeding but initial presentation may be as a metastases

36
Q

describe carcinosarcoma?

A

rare (<5%)
high grade carcinomatous and sarcomatous elements
heterologous elements commonly seen in 50% of cases (rhabdomyosarcoma, chondrosarcoma, osteosarcoma)
- presence of rhabdomyosarcoma has worst prognosis
generally bad outcome

37
Q

what is a leiomyoma and how does is present?

A

benign smooth muscle tumour (fibroid)

associated with menorrhagia and infertility

38
Q

what is a leiomyosarcoma?

A

malignant smooth muscle tumour commonly displaying a spindle cell morphology
most common uterine sarcoma

39
Q

features of leiomyosarcoma?

A

usually in women >50

causes vaginal bleeding, palpable pelvic mass and pelvic pain

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