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Reproductive and sexual medicine > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

(45 cards)

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1
Q

What is the most common form of endometrial cancer

A

Adenocarcinoma

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2
Q

What is hyperplasia

A

An increase in number of cells in a tissue or organ

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3
Q

Suspected diagnosis: Postmenopausal bleeding

A

Endometrial cancer until proven otherwise

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4
Q

What are the 3 forms of endometrial hyperplasia

A

Simple
Complex
Atypical (Precursor)

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5
Q

What causes endometrial hyperplasia?

A

Unopposed oestrogen stimulation

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6
Q

Histological characteristics of simple endometrial hyperplasia

A

General distribution
Glands and stroma
Dilated
Normal cytology

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7
Q

Histological characteristics of complex endometrial hyperplasia

A

Focal distribution
Glandular
Crowded
Normal cytology

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8
Q

Histological characteristics of atypical; endometrial hyperplasia

A

Focal
Glandular
Crowded
Atypical cytology

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9
Q

What are the 2 main groups of endometrial carcinoma

A

Endometrioid carcinoma and mucinous (Type 1)
Serous carcinoma and clear cell (Type 2)

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10
Q

What is the precursor lesion for endometrioid carcinoma

A

Atypical endometrial hyperplasia

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11
Q

What is the precursor lesion for endometrial serous carcinoma

A

Serous intraepithelial carcinoma

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12
Q

Is endometrioid (T1) carcinoma related to unopposed oestrogen?

A

Yes

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13
Q

What are some mutations common in endometrioid carcinoma (T1)

A

PTEN
KRAS
PIK3CA
Microsatellite instability (Lynch syndrome)

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14
Q

Is serous carcinoma (T2) associated with unopposed oestrogen?

A

No

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15
Q

What are some characteristics of serous endometrial carcinoma

A

Common in early post-menopause
Spreads along fallopian tube mucosa
More aggressive than endometrioid

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16
Q

How is serous carcinoma characterised histologically

A

complex papillary or glandular architecture with diffuse, marked nuclear pleomorphism

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17
Q

What are some rarer forms of endometrial cancer?

A

Endometrial stromal sarcoma
Carcinosarcoma

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18
Q

What are some characteristics of endometrial stromal sarcoma

A

Arises from endometrial storm
Can be low or high grade
Infiltrate myometrium and lymphovascular space
Metastaise to ovary or lung

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19
Q

What are some characteristics of carcinosarcoma

Study These Flashcards
A

Mixed tumour with malignant epithelial and stromal elements
They have high grade carcinomatous and sarcomatous elements

Other elements such as rhabdomyosarcoma, chondrosarcoma or osteosarcoma are seen in around 50% of cases

These are usually associated with poor outcome

20
Q

How is endometrial hyperplasia managed?

Study These Flashcards
A

LNG-IUD (Mirena)
Continuous oral progestogens

21
Q

What are some risk factors for endometrial cancer?

Study These Flashcards
A
  • Increased age
  • Earlier onset of menstruation
  • Late menopause
  • Oestrogen only hormone replacement therapy
  • No or fewer pregnancies
  • Obesity
  • Polycystic ovarian syndrome
  • Tamoxifen
22
Q

How can PCOS increase endometrial cancer risk

Study These Flashcards
A

In PCOS, no ovulation occurs, so no corpus luteum forms to produce progesterone
This leads to unopposed oestrogen

23
Q

What protection is used in people with PCOS to prevent endometrial cancer

Study These Flashcards
A
  • CHC
  • Mirena coil
  • Cyclical progestogens
24
Q

What are some examples of cyclical progestogens?

Study These Flashcards
A

Medroxyprogesterone
Levonorgestrel

25
How can obesity increase risk of endometrial cancer
Adipose tissue is a source of oestrogen (Especially in post-menopausal women) The adrenal glands produce testosterone in women Adipose tissue uses aromatase to convert testosterone into oestrogen
26
Why does tamoxifen increase risk of endometrial cancer?
It has an anti-oestrogenic effect on the breast tissue but an oestrogen effect on the endometrium
27
Why does type 2 diabetes increase risk of endometrial cancer?
Increased insulin production stimulates endometrial cell proliferation
28
What are some protective factors for endometrial cancer
- Combined contraceptive pill - Mirena coil - Increased pregnancies - Cigarette smoking
29
How is smoking protective of endometrial cancer?
Anti-oestrogenic effect Increases weight loss decreasing adipose tissue Destroys oocytes resulting in earlier menopause
30
How will endometrial cancer present?
Post-menopausal bleeding Post-coital bleeding Intermenstrual bleeding Unusually heavy menstrual bleeding Abnormal vaginal discharge Haematuria Anaemia Raised platelet count
31
Referral criteria for 2-week-wait urgent cancer referral for endometrial cancer
Post-menopausal bleeding (>1 year since last menstrual period)
32
Referral criteria for transvaginal US in those over 55
Unexplained vaginal discharge Visible haematuria plus raised platelets, anaemia or elevated glucose levels
33
Investigations required for endometrial cancer
Transvaginal ultrasound - Endometrial thickness Pipelle biopsy Hysteroscopy + Biopsy
34
Normal pre-menopausal endometrial thickness?
<16mm
35
Normal post-menopausal endometrial thickness
<4mm
36
How is pipette biopsy performed
Outpatient clinic Speculum exam plus pipelle (Thin tube) inserted through cervix
37
FIGO stage 1 endometrial cancer
Confined to the uterus
38
FIGO stage 2 endometrial cancer
Invades the cervix
39
FIGO stage 3 endometrial cancer
Invades the ovaries, fallopian tubes, vagina or lymph nodes
40
FIGO stage 4 endometrial cancer
Invades bladder, rectum, or beyond the pelvis
41
Management of stage 1 and 2 endometrial cancer
total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH + BSO)
42
What are some other management options for endometrial cancer?
Radical hysterectomy Radiotherapy Chemotherapy Progesterone (Slows growth)
43
What is a malignant cancer of the myometrium called?
Leiomyosarcoma
44
Symptoms of leiomyosarcoma?
Abnormal vaginal bleeding Palpable pelvic mass Pelvic pain
45
Prognosis of leiomyosarcoma
15-25% 5 year survival

Reproductive and sexual medicine (78 decks)

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