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REPRODUCTION & GYNAECOLOGY > Uterine Cancer > Flashcards

Uterine Cancer Flashcards

1
Q

What are the most common causes of dysfunctional uterine bleeding?

A

Endometrial polyps

Endometrial hyperplasia

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2
Q

What are polyps? When do they normally occur? What do they contain?

A
  • overgrowth of endometrium
  • contain glands and stroma
  • typically benign but can be malignant
  • often occur around or after the menopause
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3
Q

If cytology is atypical there is a low risk of progression to cancer. TRUE/FALSE?

A

FALSE

- high risk of progression to endometrial cancer

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4
Q

Describe the difference in histological appearance between simple and complex endometrial hyperplasia?

A

SIMPLE

  • glands irregular shaped rather than round
  • glands dilated but not crowded
  • Lots of stroma visible

COMPLEX
- glands crowded and push stroma away
=> not much stroma present
- normal nuclei lining up along bottom of cells (as complex hyperplasia is not atypical)

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5
Q

Cytology in both simple and complex endometrial hyperplasia is normal. TRUE/FALSE?

A

TRUE

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6
Q

If cytology is abnormal and there is a high risk of developing endometrial cancer what treatment is offered?

A

Hysterectomy

as long as no contraindications

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7
Q

What signs on histology of endometrial hyperplasia would indicate that malignancy is present?

A
  • once glands start to fuse
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8
Q

What is thought to cause endometrial hyperplasia?

A

Causes: often unknown

BUT may be persistent oestrogen stimulation

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9
Q

At what age is endometrial carcinoma most common?

A

Peak incidence 50 ‐ 60 years

uncommon under 40

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10
Q

If a younger woman was to present with endometrial carcinoma, what underlying causes may you consider?

A
  • Polycystic ovary syndrome (PCOS)

- Lynch syndrome (Hereditary Non-Polyposis Colorectal Cancer)

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11
Q

Patients with Lynch Syndrome (Hereditary Non-Polyposis Colorectal Cancer) are just as likely to have their first presentation be an endometrial cancer instead of a colorectal cancer. TRUE/FALSE?

A

TRUE

- condition is usually picked up on presentation of either cancer

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12
Q

What are the precursor lesions to endometrial cancer?

A

Endometrioid carcinoma
=> precursor atypical hyperplasia

Serous carcinoma
=> precursor serous intraepithelial carcinoma

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13
Q

How does endometrial carcinoma usually appear macroscopically?

A

Macroscopic

  • Large uterus
  • polypoid appearance
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14
Q

How does endometrial carcinoma usually appear microscopically?

A

• Microscopic
– Most are adenocarcinomas (glandular tissue)
– Most are well differentiated

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15
Q

How do endometrial carcinomas usually spread?

A

• Spread
– Directly into myometrium and cervix
– Lymphatic
– Haematogenous

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16
Q

What are the 2 main types of endometrial carcinoma?

A
  1. Endometrioid (and mucinous) – TYPE 1 tumours (80%)
    - Due to unopposed oestrogen
    - From atypical hyperplasia
  2. Serous (and clear cell) – TYPE 2 tumours
    - Not associated with unopposed oestrogen
    - Affect elderly post‐menopausal women
    - TP53 often mutated => aggressive cancers
17
Q

What genetic mutations are associated with Type 1 Endometrioid tumours?

A

PTEN, KRAS, PIK3CA mutations

18
Q

Why does obesity increase the risk of endometrial cancer?

A
  • Adipocytes express aromatase
    => converts ovarian androgens into oestrogens
    => endometrial proliferation
  • Insulin action is often altered in obese women
  • insulin-binding globulins = reduced
  • free insulin levels = elevated
  • Insulin and insulin-like growth factors (IGF) make endometrium proliferate
19
Q

Why does Lynch syndrome put women at an increased risk of cancer?

A
  • inheritance of a defective DNA mismatch repair gene
    => when cells are proliferating and mutate, they are not removed properly
  • causes microsatellite instability (short stretches of DNA are not the same across all cells anymore) - this is a symptom of DNA mismatch repair
20
Q

Lynch Syndrome is Autosomal ___________?

A
  • Autosomal dominant
21
Q

How do serous endometrial carcinomas spread ?

A

Spreads along Fallopian tube mucosa and peritoneal surfaces
=> can easily present with extrauterine disease
=> More aggressive than endometrioid carcinoma

22
Q

Describe the histological appearance of serous endometrial carcinoma?

A
  • complex papillary and/or glandular architecture
  • nuclear pleomorphism
  • inflammatory cells due to reaction with myometrium
  • myometrial invasion
23
Q

Describe the histological appearance of an endometrial clear cell cancer?

A
  • rounded glands

- cogwheel change (lines into centre of round gland)

24
Q

Endometroid carcinoma is usually confined to the uterus at presentation. TRUE/FALSE?

A

TRUE

=> good prognosis

25
Q

What factors is the prognosis of endometrial carcinoma based upon?

A

Stage (I-IV)
Histological grade
Depth of myometrial invasion

26
Q

Describe how endometrioid carcinomas are staged according to their architecture

A
  • if well differentiated - still looks like glandular tissue
  • if it gets aggressive, glandular cells forget what type of tissue they are meant to form, and instead form solid sheets

Grade 1 5% or less solid growth
Grade 2 6-50% solid growth
Grade 3 >50% solid growth

27
Q

How are endometrial tumours usually staged (I-IV)?

A

I - myometrial invasion
II - cervical stroma invasion
III - Local spread
IV - Distant metastases or invading bladder/bowel

28
Q

What other endometrial cells can become cancerous?

A

Endometrial stromal sarcoma
- tumour from mesenchyma

Carcinosarcoma

  • Mixed tumour => epithelial and stromal elements
  • Still a carcinoma but goes crazy and can form bone, cartilage or neuro tissue
29
Q

Once a tumour breaches the serosa of the uterus how does it spread?

A

“falls off”
=> into pelvis
=> onto omentum
=> into Pouch of Douglas

30
Q

How are carcinosarcomas usually treated and why may this be a problem in the age group this cancer are normally found in?

A
  • Treated like serous carcinomas (aggressive)
  • Patient group is normally elderly
    => may not be suitable for surgery/ chemotherapy
31
Q

How do leiomyomas usually appear macroscopically?

A
  • white/grey colour

- covered by layer of endometrium => will bleed at correct time of month

32
Q

What symptoms are common when a patient has uterine fibroids?

A

menorrhagia

infertility

33
Q

At what age do leiomyosarcomas usually occur and how do they normally present?

A

> 50 years

- present with abnormal bleeding and a palpable pelvic mass (they are usually large when diagnosed)

34
Q

Leiomyomas are easily identified macroscopically but are difficult to identify microscopically. TRUE/FALSE?

A

TRUE

  • microscopic appearance looks like almost normal smooth muscle
  • spindles just run in slightly different directions

REPRODUCTION & GYNAECOLOGY (58 decks)

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