Endometrial carcinoma

Question 1

what types of endometrial carcinomas are there?

Answer 1

Type 1 and Type 2

Question 2

what are examples of type 1 endometrial tumours?

Answer 2

-Mucinous carcinoma
-Endometrioid carcinoma

Question 3

what is the precursor for type 1 endometrial carcinomas?

Answer 3

type 1 endometrial carcinomas= mucinous and endometrioid carcinomas

precursor= atypical hyperplasia

Question 4

what hormone is atypical hyperplasia of the endometrium related to?

Answer 4

endometrial atypical hyperplasia is related to unopposed oestrogen

Question 5

what mutations are associated with type 1 endometrial carcinoma?

Answer 5

type 1 endometrial carcinoma= mucinous and endometrioid carcinoma

Mutations associated with type 1 endometrial carcinoma:
-PTEN
-KRAS
-PIK3CA

Question 6

are type 1 or type 2 endometrial carcinomas more common?

Answer 6

type 1 endometrial carcinomas (80%) are more common than type 2 endometrial carcinomas (20%)

Question 7

examples of type 2 endometrial carcinomas?

Answer 7

type 2 endometrial carcinomas:
-Serous carcinoma
-Clear cell carcinoma

Question 8

are type 1 or type 2 endometrial carcinomas more aggressive?

Answer 8

type 2 are more agressive (serous and clear cell carcinomas)

Question 9

precursor for type 2 endometrial carcinomas?

Answer 9

(type 2= serous and clear cell carcinomas)

Precursor for type 2 endometrial carcinoma:
-serous intreaepithelial carcinoma

Question 10

who is more likely to get a type 2 endometrial carcinoma?

Answer 10

type 2 endometrial carcinoma= serous and clear cell carcinoma

more common in:
-elderly and post menopausal
-TP53 mutation

Question 11

what mutation is associated with type 2 endometrial carcinoma?

Answer 11

type 2 endometrial carcinoma= serous and clear cell carcinoma

mutation= TP53

Question 12

how does type 2 endometrial carcinoma spread?

Answer 12

spreads along fallopian tube mucosa and peritoneal surfaces and so can present with extrauterine disease

Question 13

what type of cancer has:
‘Complex papillary and/or glandular architecture with diffuse, marked nuclear polymorphism’

Answer 13

Serous carcinoma (type 2 endometrial cancer)

Question 14

first line investigation for endometrial carcinoma?

Answer 14

transvaginal USS to measure endometrial thickness

in post menopausal normal <4mm

Question 15

what is a normal endometrial thickness of a post menopausal woman?

Answer 15

<4mm

Question 16

what is stage 1 endometrial carcinoma? (FIGO staging)

Answer 16

Stage 1= confined to uterus
1A no or <50% myometrium invaded
1B 50% or >50% of myometrium invaded

Question 17

what is stage 2 endometrial carcinoma? (FIGO staging)

Answer 17

Stage 2= cancer invades cervix

Question 18

what is stage 3 endometrial carcinoma? (FIGO staging)

Answer 18

Stage 3= cancer invades ovaries, fallopian tubes, vagina or lymph nodes

Question 19

what lymph nodes do endometrial carcinomas tend to invade?

Answer 19

para- aortic lymph nodes

Question 20

what is stage 4 endometrial carcinoma (FIGO staging)

Answer 20

stage 4= invasion of bladder, rectum or beyond pelvis

Question 21

Treatment for stage 1 endometrial carcinoma?

Answer 21

treatment for stage 1 + 2 endometrial cancer is the same

-total abdominal hysterectomy with bilateral salpingooophorectomy

Question 22

Treatment for stage 2 endometrial cancer?

Answer 22

treatment for stage 1 + 2 endometrial cancer is the same

-total abdominal hysterectomy with bilateral salpingooophorectomy

Question 23

Treatment for stage 3 endometrial cancer?

Answer 23

maximal debulking surgery + radiotherapy + chemotherapy

Question 24

treatment for stage 4 endometrial cancer?

Answer 24

maximal debulking surgery + palliative approach (low dose radiotherapy)

Question 25

how are type 2 endometrial carcinomas typically graded and treated?

Answer 25

Type 2 are more aggrressive and so are immediately high graded treatment= extensive surgery + chemo/radiotherapy

Question 26

what can be used to shrink endometrial carcinomas in patients who cant have surgery?

Answer 26

-high dose oral progesterones -radiotherapy

Question 27

is radiotherapy or surgery more effective ?

Answer 27

surgery is more affective in most gynaecological cancers

Question 28

what should be considered in a young woman with endometrial carcinoma?

Answer 28

consider underlying predisposition: -Lynch syndrome -PCOS

Question 29

risk factors for endometrial carcinoma?

Answer 29

-Obesity 50-60 years -Post menopausal women -Nullparity -Prolonged period of anovultation e.g. early menarche/ late menopause, low parity, PCOS young women with endometrial carcinoma, think PCOS or Lynch syndrome

Question 30

how do endometrial carcinomas spread?

Answer 30

-Directly into myometrium and cervix -Lymphatic -Haematogenous

Question 31

presentation of endometrial carcinoma?

Answer 31

Abnormal bleeding * Most commonly postmenopausal bleeding * Post coital bleeding * Intermenstrual bleeding Abnormal vaginal discharge Haematuria

Question 32

inheritance of Lynch syndrome (HNPCC) ?

Answer 32

autosomal dominant

Question 33

what cancers are you most likely to inherit from Lynch syndrome (HNPCC)?

Answer 33

Colerectal cancer (most common) Endometrial cancer Ovarian cancer Pancreatic cancer

Question 34

what are protective factors of endometrial carcinoma?

Answer 34

multiparity combined oral contraceptive pill smoking (the reasons for this are unclear)

Question 35

prognosis for endometrial carcinoma?

Answer 35

good prognosis for stage 1 there is a 85-90% survival rate

Question 36

treatment for post menopausal women with atypical endometrial hyperplasia

Answer 36

total hysterectomy and bilateral salpingo-oophrectomy

Question 37

treatment for women with atypical endometrial hyperplasia?

Answer 37

total hysterectomy