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Endometrial cancer Flashcards

(53 cards)

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1
Q

what are the two pre cursors for cancer that cause DUB

A

endometrial polyps and endometrial hyperplasia

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2
Q

1 thing about endometrial polyps

when do they occur

A

common

around/after menopause

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3
Q

the different types of endometrial hyperplasia and what is it

A

an increase in glands or an increase in the stroma

simple, complex, atypical (precursor of carcinoma)

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4
Q

what do endometrial polyps cause

A

non menstrual bleeding

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5
Q

what is the cause for endometrial hyperplasia

A

unknown

may be persistent oestrogen stimulation

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6
Q

how does someone with endometrial hyperplasia present

A

abnormal bleeding DUB pre menopausal or post menopausal bleeding

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7
Q

simple hyperplasia

distribution
component
glands
cytology

A

general distribution
glands and stroma
dilated not crowded
normal cytology

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8
Q

complex hyperplasia

distribution
component
glands
cytology

A

focal
glands
crowded
normal

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9
Q

atypical hyperplasia

distribution
component
glands
cytology

A

focal
glands
crowded
atypical

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10
Q

histology of simple hyperplasia

A

generalised abnormality
cystic dilatation of the glands
cytology normal

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11
Q

histology of complex hyperplasia

A

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

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12
Q

histology of complex atypical hyperplasia

A

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

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13
Q

chance of complex atypical hyperplasia progressing onto malignancy

A

25%

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14
Q

age for endometrial cancer

A

peak 50-60

uncommon <40

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15
Q

what should be considered in young women with endometrial cancer

A

PCOS or Lynch syndrome

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16
Q

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

A

endometrial carcinoma - atypical hyperplasia

serous carcinoma - serous intraepithelial carcinoma

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17
Q

how does endometrial carcinoma present

A

abnormal bleeding

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18
Q

what does endometrial carcinoma looks like macroscopically

A

large uterus
polypoid
like a grapefruit

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19
Q

what does endometrial cancer looks like microscopically

A

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

and are usually well differentiated

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20
Q

spread of endometrial cancer

A

myometrium then into the cervix
lymphatic
haematogenous

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21
Q

Type 1 endometrial cancers

A

endometriod and mucinous (80%)

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

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22
Q

how is mucinous graded

Study These Flashcards
A

always low grade

just produced mucin

23
Q

type 2 endometrial cancers

Study These Flashcards
A

serous and clear cell

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

24
Q

which kind of endometrial carcinoma is rare

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

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