Uterine malignancy

Question 1

Define an anovulatory menstrual cycle

Answer 1

A menstrual cycle characterized by varying degrees of menstrual intervals and the absence of ovulation and a luteal phase - in absence of ovulation there will be infertility e.g. perimenopause, poly cystic ovaries

Question 2

What are the 2 main precursors to endometrial cancer?

Answer 2

Endometrial polyps and endometrial hyperplasia

Question 3

What are endometrial polyps and how are the potentially a precursor for endometrial carcinoma ?

Answer 3

Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity.

They are potentially precursors to endometrial carcinoma because endometrial hyperplasia and invasive carcinoma can present as a polyp, but they are usually benign unless presenting life previously mentioned.

Question 4

What causes uterine polyps to develop ?

Answer 4

Anovulatory cycles - therefore most common in women who are going through or have completed menopause

Question 5

What is the typical presentation of uterine polyps ?

Answer 5

• Irregular menstrual bleeding — for example, having frequent, unpredictable periods of variable length and heaviness
• Bleeding between menstrual periods
• Excessively heavy menstrual periods
• Vaginal bleeding after menopause
• Infertility

Some women have only light bleeding or spotting; others are symptom-free

Question 6

What causes endometrial hyperplasia ?

Answer 6

• Most often is caused by excess estrogen without progesterone. If ovulation does not occur, progesterone is not made, and the lining is not shed.
• The endometrium may continue to grow in response to estrogen. The cells that make up the lining may crowd together and may become abnormal. This condition, called hyperplasia, may lead to cancer in some women.

Question 7

When does endometrial hyperplasia usually occur ?

Answer 7

Usually occurs after menopause, when ovulation stops and progesterone is no longer made.

Question 8

What are the 3 main types of endometrial hyperplasia ?

Answer 8

1. Simple
2. Complex
3. Atypical

Question 9

Which of the 3 types of endometrial hyperplasia is the true precursor for endometrial carcinoma ?

Answer 9

Atypical hyperplasia

Question 10

What can endometrial hyperplasia present with ?

Answer 10

Abnormal bleeding (dysfunctional uterine bleeding or postmenopausal bleeding).

Question 11

Appreciate this pic of normal endometrium

Question 12

What are the features of simple, complex and atypical hyperplasia in terms of:

1. Distribution
2. Component invovled
3. Glands appearance
4. Cytology

Answer 12

refer to cervical cancer lecture for features of abnormal cytology/malignancy

Question 13

Label the types of endometrial hyperplasia shown

Answer 13

from left to right goes, simple, complex and then atypical hyperplasia

Question 14

What are the risk factors for developing endometrial carcinoma ?

Answer 14

• Obesity
• Excessive exposure to oestrogen unopposed by progesterone
• Functioning ovarian tumour
• Fam history of breast,ovary or colon cancer (lynch syndrome)
• Nulliparity - as having a kid provides a protective period of time from oestrogen reducing the chances of endometrial cancer development
• Late menopause so incresed oestrogen exposure throughout life
• Diabetes
• Tamoxifen and tibolone
• Pelvic irradiation
• Polycystic ovaries

Question 15

What is the classic features for presentation of endometrial carcinoma ?

Answer 15

Postmenopausal bleeding

• This bleeding is typically scanty and occasional +/- watery discharge
• Bleeding then becomes regular and heavy
• Premenopasual women may have intermenstrual bleeding

Unlikely to have others unless the disease is well advanced

Question 16

How is endometrial carcinoma diagnosed ?

Answer 16

1st - Uterine transvaginal US may be suggestive if increased thickness seen

2nd for absolute diagnosis = by uterine sampling via hysteroscopy or curretage

Question 17

What is the common age of presentation of endometrial carcinoma ?

Answer 17

50-60 it is uncommon to occur in <40

Question 18

If endometrial carcinoma does occur in a women <40 what might you think has caused this?

Answer 18

Predisposition with polycystic ovarian syndrome or lynch syndrome

Question 19

What is the most common type of endometrial carcinoma ?

Answer 19

Adenocarcinoma - they are usually well-differentiated and present at an early stage with bleeding which means surgery often curative

Question 20

What are the precursor lesions for the 2 types of endometrial adenocarcinomas?

Answer 20

1. Endometrioid carcinoma: precursor atypical hyperplasia
2. Serous carcinoma: precursor serous intraepithelial carcinoma

Question 21

Describe the typical way in which endometrial carcinoma spreads

Answer 21

Invading directly into the underlying myometrium and cervix

Then to the surrouding (adenexal) lymphatics ==> tumour can spread often to the ovaries

Haematogenous spread may also occur

Question 22

Describe the macroscopic appearance of endometrial carcinoma

Answer 22

• Large uterus
• Polypoid (mutiple polyp like growths)

Question 23

What are the 2 main classes of endometrial adenocarcinoma and which is the most common ?

Answer 23

1. Endometrioid (mucinous) adenocarcinoma know as type 1 - most common
2. Serous (clear cell) adenocarcinoma know as type 2