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Flashcards in Endometrial cancer Deck (53):
1

what are the two pre cursors for cancer that cause DUB

endometrial polyps and endometrial hyperplasia

2

1 thing about endometrial polyps
when do they occur

common
around/after menopause

3

the different types of endometrial hyperplasia and what is it

an increase in glands or an increase in the stroma

simple, complex, atypical (precursor of carcinoma)

4

what do endometrial polyps cause

non menstrual bleeding

5

what is the cause for endometrial hyperplasia

unknown
may be persistent oestrogen stimulation

6

how does someone with endometrial hyperplasia present

abnormal bleeding DUB pre menopausal or post menopausal bleeding

7

simple hyperplasia

distribution
component
glands
cytology

general distribution
glands and stroma
dilated not crowded
normal cytology

8

complex hyperplasia

distribution
component
glands
cytology

focal
glands
crowded
normal

9

atypical hyperplasia

distribution
component
glands
cytology

focal
glands
crowded
atypical

10

histology of simple hyperplasia

generalised abnormality
cystic dilatation of the glands
cytology normal

11

histology of complex hyperplasia

relatively small glands
very little stroma - still present tho
nuclei are lined at the bottom of the gland - not atypical

12

histology of complex atypical hyperplasia

glands are angulated
not much stroma between the glands
nuclei are atypical

13

chance of complex atypical hyperplasia progressing onto malignancy

25%

14

age for endometrial cancer

peak 50-60
uncommon <40

15

what should be considered in young women with endometrial cancer

PCOS or Lynch syndrome

16

what are the two main groups of endometrial carcinoma and the different precursors for each one

endometrial carcinoma - atypical hyperplasia

serous carcinoma - serous intraepithelial carcinoma

17

how does endometrial carcinoma present

abnormal bleeding

18

what does endometrial carcinoma looks like macroscopically

large uterus
polypoid
like a grapefruit

19

what does endometrial cancer looks like microscopically

most are adenocarcinomas - form glands of the endometrium rather than the stroma

and are usually well differentiated

20

spread of endometrial cancer

myometrium then into the cervix
lymphatic
haematogenous

21

Type 1 endometrial cancers

endometriod and mucinous (80%)

related to unopposed oestrogen w/o opposing prog (like in PCOS)
associated with atypical hyperplasia

22

how is mucinous graded

always low grade
just produced mucin

23

type 2 endometrial cancers

serous and clear cell

not associated with unopposed oestrogen
elderly post menopausal women
TP53 usually mutated

24

which kind of endometrial carcinoma is rare

clear cell

25

Type 1 have what kind of mutations
associated with what
have what kind of instability -

PTEN, KRAS, PIK3CA

atypical hyperplasia as a precursor lesion

micro satellite instability - germline mutation of mismatch repair genes (Lynch)

26

histology of endometriod cancer

bands of smooth muscle at the bottom
tumour has glands

27

what is a very big risk factor for endometrial cancer and why

obesity

ovarian androgens are converted into oestrogen which induces endometrial proliferation

28

who is lynch syndrome considered in

any women under 60

29

what is lynch syndrome

defective DNA mismatch repair gene
ADom

high risk of colorectal cancer
endometrial cancer
ovarian cancer

30

what else do lynch tumours show

micro satellite instability MSI - characteristic of defective mismatch repair

31

how are tumours checked to see if lynch syndrome is present

immunochemistry staining of the tumour for mismatch repair proteins

32

type 2 tumours are what kind
mutation
precursor
spread
what kind is it
treatment

serous and clear cell

TP53 and overexpression

serous endometrial intraepithelial carcinoma

spreads along fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease - even if serous cancer only grows on the surface it can still spread up and out into the peritoneum via the fallopian tubes

33

serous carcinoma histology

characterised by a complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism

34

what is clear cell carcinoma associated with

only 10% is associated with P53 mutation

35

what does endometrial cancer usually infiltrate

myometrium

36

where can serous carcinoma spread

early to the peritoneal cavity

37

prognosis of endometrioid cancer

usually good as usually confined to uterus at presentation

38

what does prognosis of endometrial carcinoma depend on

stage
histological grade
depth of myometrial invasion

39

treatment go endometrial carcinoma

hysterectomy
chemo/radio

40

endometrioid cancer grading

grade 1 5% or less solid growth. well differentiated
2 6-50% solid growth - poorly differentiated
3 >50% solid growth - aggressive

41

what are serous carcinoma and clear cell carcinoma graded as

high grade by definition

42

staging 1A
1B
2
3
3A
3B
3C
4

1A - no or <50% mymometrial invasion
1B - invasion equal to or >50% of myometrium
2 - tumour invades cervical stroma
3 - local and or regional tumour spread
3A - tumour invades serosa of uterus and or adnexea
3B - vaginal and/or parametrise involvement
3C - mets to pelvic and/or para aortic LNs
4 - tumour invades bladder or bowel mucosa and or distant mets

43

endometrial stromal sarcoma

arises from endometrial sarcoma

44

types of endometrial stroll sarcoma

low grade
high - increased atypical, proliferative activity, more aggressive

45

presentation of endometrial stroll sarcoma

abnormal uterine bleeding but initial presentation may be mets - ovary/lung

46

mets in endometrial stromal sarcoma

even low grade can gets mets

47

carcinosarcoma

mixed tumour with epithelial and stromal elements

very aggressive

48

hetereolgous cercinosarcomas

commonly seen in 50% of cases - rhabdomyosarcoma, chrondrosarcoma, osteosarcoma

49

presence of rhabdomyosarcoma means what

worst prognosis

50

two types of smooth muscle tumours of the myometrium

leiomyoma - fibroid

leiomyosarcoma

51

fibroids are what
associated with

very common
associated with menorrhagia, infertility

52

what is a leiomyosarcoma

malignant smooth muscle tumour displaying spindle cell morphology

53

age of leiomyosarcomas
symptoms
prognosis

>50

abnormal vaginal bleeding, palpable pelvic mass, pelvic pain

poor prognosis even if confined to uterus at time of presentation