Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Week 6-Uterine cancer > Flashcards

Week 6-Uterine cancer Flashcards

1
Q

What can cause dysfunctional uterine bleeding?

A

Could be endometrial polyps- these are common

Could be endometrial hyperplasia (growth)- this can be divided into simplex, complex or atypical (precursor of carcinoma).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do endometrial polyps often occur?

A

Around menopause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is atypical in atypical hyperplasia?

A

It refers to the cytology (what the cells look like)- can only be diagnosed by a pathologist under the microscope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of endometrial hyperplasia?

A

The cause is often unknown, however may be in relation to oestrogen stimulation. This could be do to constant oestrogen stimulation without the progesterone influence that would have caused the lining to shed. This leads to growing of the glands, they become bigger and cystically dilated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe simple endometrial hyperplasia?

A

Simple affects the whole endometrium. You get hyperplasia of glands and stroma, and dilation of glands.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe complex endometrial hyperplasia?

A

This is when the glands become crowded. Typically this occurs as a focal abnormality. Cytology is still normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe atypical endometrial hyperplasia?

A

Here you have crowded glands, proliferation of glands and stroma however the cell type is atypical.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Microscopic appearence of normal proliferative endothelium.

A

Here you can see mitotic figures in the glands. Showing proliferation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

This shows simple hyperplasia.

A

The stroma is increased in size and so have the glands. You are very unlikely to find atypical cells in this.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

This slide shows complex hyperplasia.

A

Small lumen with a more complex architecture. Nuclei are still present and look normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

This slide shows complex atypical hyperplasia.

A

The glands are crowded and look cytologically atypical. Cells tended to be round (they used to be cigar shaped). Often prominent nuclei which has lost its polarity (it doesnt sit on the BM but further up in the cell).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is the peak incidence for endometrial carcinoma?

A

50-60 years.

Unlikely to be present in less than 40.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do you treat atypical hyperplasia? why do you treat it?

A

Treat it with hysterectomy. Treat it because there is a high risk of acquiring/already having endometrial carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should you consider in young women with suspected endometrial carcinoma/DUB?

A

Precursor lesions e.g. PCOS and Lynch syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What two main groups can endometrial carcinoma be broken into?

A

Endometroid carcinoma or serous carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the precursor lesion for endometroid carcinoma?

A

Precursor is atypical hyperplasia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the precursor lesion for serous carcinoma?

A

Precursor is serous intraepithelial carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does endometrial carcinoma usually present?

A

Abnormal uterine bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Macroscopically, how may an endometrial carcinoma look?

A

Large uterus.

Polypoid (like a polyp).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How will endometrial carcinoma appear microscopically?

A

Most are adenocarcinomas that are well differentiated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where can endometrial carcinomas spread?

A

They can only spread into the myometrium or the cervix. You have to assess how much of the myometrium they have invaded to see if there is a chance they’ve gained access to lymphatics or blood (bigger vessels so easier spread).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common type of endometrial cancer?

A

Endometroid (and mucinous (a variant of endometroid) also known as type 1 (80%).

Then serous- also known as type 2 makes up the other 20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which endometrial cancer is associated with unnoposed oestrogen?

A

Endometroid.

24
Q

Which gene is often mutated in serous endometrial cancer?

A

TP53.

25
Q

Why is the mucinous variant of endometroid endometrial carcinoma called this?

A

It produces mucin.

26
Q

Which mutations are associated with type 1 tumours (endometroid and mucinous)?

What is meant by microsatellite instability in these tumours?

A

PTEN, KRAS, PIK3CA

Short stretches of DNA called microsatellites. As tumours grow they acquire mutations and abnormalities in these.

27
Q

What is Lynch syndrome? Where is the mutation?

A

Also known as Hereditary nonpolyposis colorectal cancer (HNPCC)

Autosomal dominent condition where you have increased risk of colorectal cancer along with other cancers (including endometrial, ovarian).

The mutation can be found in germline mismatch repair genes.

28
Q

This is endometroid endometrial carcinoma.

A

The darker pink bands are the myometrium at the bottom.

You cant really make out where one gland ends and another starts. There is a lack of stroma between the glands.

29
Q

What investigation can help diagnose Lynch syndrome?

A

Immunohistochemistry staining.

30
Q

Is obesity a risk factor for endometrial cancer? Why is this?

A

YES.

Adipocytes express aromotase that convert ovarian androgens into oestrogens, which induce endometrial proliferation. Sex hormone binding globulin levels are lower in obese women so the amount of unbound hormone is higher.

Also insulin levels are often altered in obese people. Levels of insulin binding hormone are often lowered so the amount of unbound hormone increases. Insulin and insulin like growth factor cause the endometrium to proliferate.

31
Q

How can you reduce the risk of obesity associated with endometrial cancer?

A

LOSE SOME WEIGHT FATTY

32
Q

What makes up type II endometrial cancers?

A

Serous (mainly) and clear cell (this is not related to renal clear cell or ovarian clear cell etc).

33
Q

Where is the mutation in serous cancers?

A

(T) P53 mutations and overexpression.

34
Q

How do type II tumours spread?

A

They spread along fallopian tubes and peritoneal surfaces so can present with extrauterine disease.

35
Q

Which types of tumours (I or II) are more aggressive? How does the treatment differ?

A

Type II.

The surgery in type II is usually more extensive and needs adjuvant chemo and radiotherapy.

36
Q

This shows serous carcinoma.

A

Shows:

Big atypical cells

No nice glands present.

Complex papillary and glandular architecture, with diffuse/nodular pleomorphism.

Next photo- prominent nucleoili. Dotty cells around the edge- are lymphocytes coming in.

37
Q

This shows clear cell carcinoma- v rare.

A

Cytoplasm is clear. Tubular structure.

38
Q

Where may serous carcinoma spread early too?

A

Peritoneal cavity.

39
Q

Where is the typical area endometrial carcinomas spread too?

A

Myometrium.

40
Q

What is meant by grading and staging?

A

Grading- how aggressive it is

Staging- how far it has spread.

41
Q

What does prognosis of endometrial carcinoma depend on?

What are the treatment options depending on the outcome of the above?

A

Staging

Histological grade

Depth of myometrial invasion.

Could treat with hysterectomy, chemo/radiotherapy.

42
Q

Describe the grading of endometrial carcinoma?

A

Endometroid cancers are graded on how much solid growth

Grade 1- 5% or less solid growth

Grade 2- 6-50% solid growth

Grade 3->50% solid growth

Serous and clear cell carcinomas are not graded.

43
Q

Describe the staging of endometrial cancer?

A

Stage I- confined to the uterus:

  • IA-no or <50% myometrial invasion.
  • IB- >50% myometrial invasion

Stage 2- tumour invades cervical stroma

Stage 3- local or regional tumour spread

  • IIIA- tumour invades serosa of uterus or adnexae
  • IIIB-Vaginal and/or parametrial involvement
  • IIIC-Metastases to pelvic and/or paraortic lymph nodes

Stage 4 tumour invades bladder and/or bowel mucosa and/or distant metastases.

44
Q

Name some other endometrial tumours?

A

Endometrial stroma sarcoma- arises from the stroma.

Carcinosarcoma-mixed tumour with malignant epithelial and stromal elements. (older term for this was mixed mullerian tumour).

45
Q

Desribe endometrial stromal sarcomas?

A

Can be low or high grade. High grade have increased atypia and proliferative activity. They infiltrate myometrium and lymphovascular spaces.

Typically presents with abnormal uterine bleeding but first presentation could be metastasis.

If you have high grade- you are likely to die from the disease.

46
Q

Describe carcinosarcomas?

A

They make up <5% of uterine malignancies

They have high grade carcinomatous and sarcomotous elements.

Other elements seen in about 50% of cases are rhabdomyosarcomas and chondrosarcomas and osteosarcomas.

Presence of rhabdomyosarcomas (tumour of skeletal muscle) has the worst prognosis.

47
Q

What is a leiomyoma?

A

A fibroid- these are benign tumours of the myometrium. They are associated with menorrhagia and infertility.

48
Q

What is a leiomyosarcoma?

A

A malignant smooth muscle cell tumour commonly displaying a spindle cell morphology. It is the most common uterine sarcoma.

49
Q

Who gets leiomyosarcomas?

A

Women>50.

50
Q

What symptoms would someone with a leiomyosarcoma present with?

A

Abnormal vaginal bleeding

Palpable pelvic mass

Pelvic pain

51
Q

What is the prognosis of leiomyosarcoma like?

A

Poor prognosis (even if its confined to the uterus at the time of diagnosis).

52
Q

Risk factors for endometrial carcinoma?

A

Nulliparity (progesterone increases in pregnancy and is protective of the uterus)

Type 2 diabetes (high insulin levels- increase endometrial growth)

Anovulatory cycles (lack of progesterone)

Breast cancer

Oestrogen only HRT

53
Q

Protective factors for endometrial carcinoma?

A

COCP

Parity

54
Q

Mainstay of treatment for endometrial cancer?

A

Radical hysterectomy with bilateral salping-ooectomy.

Can give post op adjuvant radiotherapy.

55
Q

What type of radiotherapy is given depending on what stage of endometrial cancer?

A

Stages I and II- brachytherapy

Stages III and IV- external beam radiotherapy.

Reproduction (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions