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Year 2 Medicine > Pathology of the Female Reproductive Tract 3 > Flashcards

Pathology of the Female Reproductive Tract 3 Flashcards

(54 cards)

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1
Q

Age standardised incidence rates of endometrial cancer (UK 1993-2016)

A
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2
Q

The predominant endometrial cancer arises in the … of the ….

A

The predominant endometrial cancer arises in the glands of the endometrium

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3
Q

Malignant neoplasm of glandular epithelium = …

A

Malignant neoplasm of glandular epithelium = adenocarcinoma

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4
Q

Over …% of women with endometrial cancer present with post menopausal bleeding

A

Over 80% of women with endometrial cancer present with post menopausal bleeding

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5
Q

Endometrium

  • Composed of glands in a specialised … with a specialised blood supply
  • Growth, maturation and regression of all three components is co-ordinated during each … cycle
A
  • Composed of glands in a specialised stroma with a specialised blood supply
  • Growth, maturation and regression of all three components is co-ordinated during each menstrual cycle
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6
Q

… vs … (endometrium)

A

normal endometrium vs adenocarcinoma

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7
Q

What is shown here?

A

Uterus opened - can see a tumour on endometrium

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8
Q

Adenocarcinomas

  • Adenocarcinomas arising at different sites in the body have different … factors, pathogenesis, appearances, … abnormalities, b…, p… and t….
  • Among adenocarcinomas arising at a single site there are multiple …, initially divided by different appearances and increasingly supplemented by understanding molecular genetic pathogenesis.
A
  • Adenocarcinomas arising at different sites in the body have different risk factors, pathogenesis, appearances, genetic abnormalities, behaviour, prognosis and treatment.
  • Among adenocarcinomas arising at a single site there are multiple subtypes, initially divided by different appearances and increasingly supplemented by understanding molecular genetic pathogenesis.
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9
Q

Subtypes of endometrial adenocarcinoma by morphology (microscopic appearance)

  • Endo…
  • S…
  • … cell
  • … (components of the previous 3)
  • Un… / De…
  • Carcino…
A
  • Endometrioid
  • Serous
  • Clear cell
  • Mixed (components of the previous 3)
  • Undifferentiated / Dedifferentiated
  • Carcinosarcomas
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10
Q

Endometrioid Adenocarcinoma

  • Endometrioid cancers show differentiation that resembles … …
A

Endometrioid cancers show differentiation that resembles endometrial glands

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11
Q

Serous cancers were thought to resemble .. … epithelium

A

Serous cancers were thought to resemble Fallopian tube epithelium

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12
Q

Clear cell cancers have clear …

A

Clear cell cancers have clear cytoplasm

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13
Q

Adenocarcinoma Subtypes

  • Adenocarcinoma subtypes with similar appearance and the same names occur at other sites
    • eg there is a clear cell carcinoma of the ovary
  • They are NOT the … …
  • If a tumour has spread to other sites it can be very difficult to work out which is the site of … and which is the site of …
A
  • Adenocarcinoma subtypes with similar appearance and the same names occur at other sites
    • eg there is a clear cell carcinoma of the ovary
  • They are NOT the same disease
  • If a tumour has spread to other sites it can be very difficult to work out which is the site of origin and which is the site of metastasis
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14
Q

Demographic and histologic studies suggest two groups of women with endometrial adenocarcinoma

  • These 2 groups differ with respect to:
    • C..
    • A..
    • M… types of …
    • M… … …
    • P… L…
    • P and T
A
  • These 2 groups differ with respect to:
    • Cause
    • Age
    • Morphologic types of tumour
    • Molecular genetic abnormalities
    • Precursor lesions
    • Prognosis and Treatment
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15
Q

Endometrial Adenocarcinoma - Type 1 and Type 2

A
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16
Q

Molecular Pathology - Endometrial Cancer

A
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17
Q

The cancer genome atlas (TCGA) published an integrated genomic classification of endometrial cancer in … groups

A
  • The cancer genome atlas (TCGA) published an integrated genomic classification of endometrial cancer in 4 groups
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18
Q

TCGA Endometrial Cancers

  • 4 groups…__​
    • … cancers (DNA pol epsilon mutations) 7%
    • … cancers (defective mismatch repair and microsatelite instability) 28%
    • Endometrial cancers with … frequency of DNA copy number alterations 39%
    • Endometrial cancers with … frequency of DNA copy number alterations 26%
A
  • Ultramutated cancers (DNA pol epsilon mutations) 7%
  • Hypermutated cancers (defective mismatch repair and microsatelite instability) 28%
  • Endometrial cancers with low frequency of DNA copy number alterations 39%
  • Endometrial cancers with high frequency of DNA copy number alterations 26%
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19
Q

Precursor lesions - Cervix

  • In the cervix, the precursor lesion to invasive squamous cell carcinoma is
    • … … …(CIN)
  • The disease process is called …
  • We detect CIN by
    • screening for HR … infection,
    • looking for … cells,
    • examining the cervix by …
    • … eg by LLETZ
A
  • In the cervix, the precursor lesion to invasive squamous cell carcinoma is
    • Cervical Intra-Epithelial Neoplasia (CIN)
  • The disease process is called dysplasia
  • We detect CIN by
    • screening for HR HPV infection,
    • looking for abnormal cells,
    • examining the cervix by colposcopy
    • Treating eg by LLETZ
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20
Q

We know much less about precursor lesions in the endometrium (compared to cervix - CIN)

  • It is assumed that the common (endometrioid) form of endometrial carcinoma has its origin in a lesion called … …
  • This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma
A
  • It is assumed that the common (endometrioid) form of endometrial carcinoma has its origin in a lesion called atypical hyperplasia
  • This is supported by temporal, genetic and morphologic continuity with endometrioid endometrial adenocarcinoma
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21
Q

The woman at risk of endometrial adenocarcinoma

  • … common … cancer of the female genital tract in UK
  • … most common cancer in women in the UK (breast, lung, colorectum)
  • Lifetime risk of 1 in …
  • Usually arises in … women
  • Peak incidence in the ..-.. y/o age group
  • Most common presenting feature is … bleeding (c80%)
A
  • Most common invasive cancer of the female genital tract in UK
  • Fourth most common cancer in women in the UK (breast, lung, colorectum)
  • Lifetime risk of 1 in 46
  • Usually arises in postmenopausal women
  • Peak incidence in the 55-65 y/o age group
  • Most common presenting feature is postmenopausal bleeding (c80%)
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22
Q

What is shown here? (endometrium??)

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A

Atypical Hyperplasia - precursor lesion in endometrium

23
Q

Lifetime risk of 1 in … (Endometrial adenocarcinoma)

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A

Lifetime risk of 1 in 46 (Endometrial adenocarcinoma)

24
Q

The most common presenting feature of endometrial adenocarcimoma is

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A

postmenopausal bleeding (80%)

25
Endometrial adenocarcinoma is the ... most common cancer in woman in the UK
fourth (after breast, lung, colorectum)
26
What is the most common invasive cancer of the female genital tract in UK?
Endometrial adenocarcinoma
27
Peak incidence of endometrial adenocarcinoma is ... (Age group?)
55-65 yo
28
_Endometrial carcinoma by age_ * Peak in ...
* Peak in postmenopausal women
29
_Risk factors for endometrial cancer_ * ... hormones and ... factors * Excess ... ... * ... ... and insulin * ... hormones & modulators * E... * F.. (Cowden’s syndrome; HNPCC) * ... not a risk
* **Endogenous** hormones and **reproductive** factors * Excess **body weight** * **Diabetes mellitus** and insulin * **Exogenous** hormones & modulators * **Ethnicity** * **Familial** (Cowden’s syndrome; HNPCC) * **Smoking** not a risk
30
Is smoking a risk factor for endometrial cancer?
No
31
_Endogenous hormones_ * Excess exposure to estrogen unopposed by progestogens * Overweight increases estrogen levels in ... women * Overweight can disrupt ovulation and progestogen production in ... women * ... ovarian disease * Some rare ... ... can produce estrogens
* Excess exposure to estrogen unopposed by progestogens * Overweight increases estrogen levels in **post menopausal** women * Overweight can disrupt ovulation and progestogen production in **pre menopausal** women * **Polycystic** ovarian disease * Some rare **ovarian neoplasms** can produce estrogens
32
_Reproduction & Endometrial Cancer_ * Pregnancy and parity ... the risk of endometrial cancer * Mechanism includes the ... from unopposed ... during pregnancy and the removal of ... cells at delivery * Early menarche and late menopause ... risk (... by 7% for each year fewer)
* Pregnancy and parity **reduce** the risk of endometrial cancer * Mechanism includes the **break** from unopposed **oestrogen** during pregnancy and the removal of **abnormal** cells at delivery * Early menarche and late menopause **increase** risk (**reduced** by 7% for each year fewer)
33
_Excess body weight & Endometrial Cancer_ * c ... % endometrial cancers are linked to excess body weight * ... - ... times increased risk in overweight women * Increased risk begins with a ... elevated BMI * Central ... (waist circumference and waist:hip ratios) may be more important than ...
* c **34** % endometrial cancers are linked to excess body weight * **2-3** times increased risk in overweight women * Increased risk begins with a **moderately** elevated BMI * Central **adiposity** (waist circumference and waist:hip ratios) may be more important than **BMI**
34
_Diabetes mellitus and insulin & Endometrial Cancer_ * Women with diabetes mellitus have a ...-fold increased risk of endometrial cancer * Hard to separate effect of insulin from excess body weight but a probably direct effect * Insulin and insulin-like growth factors may increase the effects of ... on the endometrium
* Women with diabetes mellitus have a **two**-fold increased risk of endometrial cancer * Hard to separate effect of insulin from excess body weight but a probably direct effect * Insulin and insulin-like growth factors may increase the effects of **estrogen** on the endometrium
35
_Exogenous hormones & modulators - Endometrial Cancer_ * Hormone replacement therapy * Unopposed estrogen (RR is ...) * Tamoxifen (RR is ..)
* Hormone replacement therapy * Unopposed estrogen (RR **6.0**) * Tamoxifen (RR **2.0**)
36
_Ethnicity & Endometrial Cancer_ * US studies show endometrial carcinoma is ... common in African American women * 13 per 105 in African-American women * 23 per 105 in white * BUT this group has higher mortality (x...) * Many variables involved * Later stage at D... * U... tumour type * S... factors and treatment * Co...
* US studies show endometrial carcinoma is **less** common in African American women * 13 per 105 in African-American women * 23 per 105 in white * BUT this group has higher mortality (**x4**) * Many variables involved * Later stage at **diagnosis** * **Unfavourable** tumour type * **Sociodemographic** factors and treatment * **Comorbidities**
37
_Evaluation of parameters informing behaviour and treatment - Endometrial Cancer_ * There are three tumour-specific parameters * Tumour ... * Tumour ... * Tumour ...
* There are three tumour-specific parameters * Tumour **type** ✔ * Tumour **grade** * Tumour **stage**
38
_Grading of Neoplasms_ * Grading reflects how much a tumour ... its ... tissue * Has to be done on tissue under a ... * Many use a three-point system * ... differentiated Grade 1 * ... differentiated Grade 2 * ... differentiated Grade 3
* Grading reflects how much a tumour **resembles** its **parent** tissue * Has to be done on tissue under a **microscope** * Many use a three-point system * **Well** differentiated Grade 1 * **Moderately** differentiated Grade 2 * **Poorly** differentiated Grade 3
39
_Grading of endometrial carcinoma_ * Normal endometrial epithelium matures to form glands * ... also form glands * The fraction of the tumour forming glands is estimated as a percentage * (then divided into three groups) * Tumour grade affects ...
* Normal endometrial epithelium matures to form glands * **Adenocarcinomas** also form glands * The fraction of the tumour forming glands is estimated as a percentage * (then divided into three groups) * Tumour grade affects **prognosis**
40
_Staging systems_ * For all neoplasms a T N M system exists * T for ...: ... spread * N for ...: ... ... deposits * M for ...: ... deposits * For gynaecological tumours a different system called ... is usually used
* For all neoplasms a T N M system exists * T for **tumour**: **local** spread * N for **nodes**: **lymph node** deposits * M for **metastasis**: **metastatic** deposits * For gynaecological tumours a different system called **FIGO** is usually used
41
What staging system is usually used for gynaecological tumours?
FIGO (not usually TNM system)
42
_FIGO Staging of Endometrial Carcinoma_ * Stage 1: Confined to ... * Stage 2: Involving ... * Stage 3: S.../A.../V.../... ... * Stage 4: B.., B..., Distant ...
* **Stage 1: Confined to corpus** * **Stage 2: Involving cervix** * **Stage 3: Serosa/Adnexa/Vagina/Lymph Nodes** * **Stage 4: Bladder, Bowel, Distant Metastasis**
43
Most ‘endometrial cancers’ arise from endometrial ... and are ...
Most ‘endometrial cancers’ arise from endometrial **glands** and are **adenocarcinomas**
44
There are several different types of adenocarcinoma – the most common is called ... because it resembles ... glands
There are several different types of adenocarcinoma – the most common is called **endometrioid** because it resembles **endometrial** glands
45
Recognizing different types of adenocarcinoma benefits patients since it informs likely ... and ...
Recognizing different types of adenocarcinoma benefits patients since it informs likely **prognosis** and **treatment**
46
* Other types of endometrial adenocarcinoma can be recognized ... * These may have distinct molecular ... and ...
* Other types of endometrial adenocarcinoma can be recognized **microscopically** * These may have distinct molecular **abnormalities** and **behaviour**
47
Endometrioid cancer has a precursor lesion called ... ...
Endometrioid cancer has a precursor lesion called **atypical hyperplasia**
48
Tumour ... estimates the degree to which the neoplasm matures and informs prognosis and treatment
Tumour grading estimates the degree to which the neoplasm matures and informs prognosis and treatment
49
Tumour ... demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment
Tumour **staging** demonstrates the extent to which a neoplasm has spread and informs prognosis and treatment
50
**Incidence of endometrial cancer has been increasing in the last ten yearsRisk factors include:**
* Endogenous hormones and reproductive factors * Excess body weight * Diabetes mellitus and insulin * Exogenous hormones & modulators * Ethnicity * Familial (Cowden’s syndrome; HNPCC)
51
Mortality from endometrial cancer has been falling however, except for women over the age of ...
Mortality from endometrial cancer has been falling however, except for women over the age of **85**
52
Neoplasm Grade 1 = ... differentiated
well differentiated
53
Neoplasm Grade 2 = ... differentiated
moderately differentiated
54
Neoplasm Grade 3 = ... differentiated
poorly differentiated

Year 2 Medicine (162 decks)

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