T3 L3 Pathology of female reproductive tract

Question 1

What is the endometrium composed of?

Answer 1

Glands in a specialised storm with specialised blood supply

Question 2

What is an adenocarcinoma?

Answer 2

Malignant neoplasm of glandular epithelium

Question 3

What are the subtypes of endometrial adenocarcinoma?

Answer 3

Endometrioid
Serous
Clear cell
Mixed
Undifferentiated
Carcinosarcomas

Question 4

What does a serous endometrial adenocarcinoma resemble?

Answer 4

Fallopian tube epithelium

Question 5

How do the 2 types of groups with endometrial adenocarcinoma differ?

Answer 5

Cause
Age
Morphologic type of tumour
Molecular genetic abnormalities
Precursor lesions
Prognosis and treatment

Question 6

What is the common age for type 1 endometrial adenocarcinoma?

Answer 6

50-60s

Question 7

What is the common age for type 2 endometrial adenocarcinoma?

Answer 7

60-70s

Question 8

What is the spread in type 1 endometrial adenocarcinoma?

Answer 8

Lymph nodes

Question 9

What is the spread in type 2 endometrial adenocarcinoma?

Answer 9

Peritoneum

Question 10

What are the 4 groups of endometrial cancer according to TCGA?

Answer 10

Ultramutated cancers
Hypermutated cancers
Endometrial cancers with low freq of DNA copy number alterations
Endometrial cancers with high freq of DNA copy number alterations

Question 11

What is the precursor lesion in invasive squamous cell carcinoma?

Answer 11

Cervical intra-epithelial neoplasia

Question 12

What is the lifetime risk of endometrial adenocarcinoma?

Answer 12

1 in 46

Question 13

What is the peak age group for endometrial adenocarcinoma?

Answer 13

55-65 years old

Question 14

What is the most common presenting feature of endometrial adenocarcinoma?

Answer 14

80% have postmenopausal bleeding

Question 15

What are the risk factors for endometrial cancer?

Answer 15

Endogenous hormones and reproductive factors
Excess body weight
Diabetes mellitus and insulin
Exogenous hormones and modulators
Ethnicity
Familial - Cowden's syndrome, HNPCC

Question 16

How do endogenous hormones contribute to a risk factor for endometrial adenocarcinoma?

Answer 16

Excess exposure to oestrogen unopposed by progestogens
PCOS
Some rare ovarian neoplasms can produce oestrogen

Question 17

How does pregnancy contribute as a risk factor for endometrial adenocarcinoma?

Answer 17

Pregnancy and parity reduces risk of endometrial cancer

Mechanism: break from unopposed oestrogen during pregnancy and removal of abnormal cells at delivery

Question 18

How is excess body weight linked as a risk factor for endometrial adenocarcinoma?

Answer 18

Increased risk begins with moderately elevated BMI

Central adiposity may be more important than BMI (waist circumference, waist : hip ratio)

Question 19

What percentage of endometrial cancers are linked to excess body weight?

Answer 19

34%

Question 20

What variables are involved when considering link between ethnicity and endometrial cancer?

Answer 20

Later stage at diagnosis
Unfavourable tumour type
Sociodemographic factors and treatment
Comorbidities

Question 21

What are the 3 tumour-specific parameters?

Answer 21

Tumour type
Tumour grade
Tumour stage

Question 22

What does grading of neoplasms represent?

Answer 22

How much a tumour resembles its parent tissue

Question 23

What is grade 1?

Answer 23

Well differentiated

Question 24

What is grade 2?

Answer 24

Moderately differentiated

Question 25

What is grade 3?

Answer 25

Poorly differentiated

Question 26

What is the staging system for neoplasms?

Answer 26

T - local spread of tumour
N - lymph node deposits
M - metastatic deposits

Question 27

Describe the staging of endometrial carcinoma

Answer 27

Stage 1 = confined to corpus
Stage 2 = involving cervix
Stage 3 = serosa / adnexa / vagina / lymph nodes
Stage 4 = bladder, bowel, distant metastasis