Pathology of the female reproductive tract part 3

Question 1

What are some of the key reasons why endometrial cancer has been steadily increasing and is now the most common gynaecological cancer in the UK?

Answer 1

• increasing age
• obesity
• nulliparity (no births) due to lack of renewal of endometrium

Question 2

There are 2 types of endometrial cancer, what are they?

Answer 2

• type 1 = endometrioid adenocarcinomas linked to estrogen

- type 2 = not linked to excess oestrogen

Question 3

There are 2 types of endometrial cancer:

• type 1 = endometrioid adenocarcinomas (glandular) linked to estrogen
• type 2 = not linked to excess oestrogen

Which is more common and more severe?

Answer 3

• type 1 is more common = 80-90% of cases

- type 2 is more aggressive with worse prognosis

Question 4

What is a adenocarcinomas?

Answer 4

• adeno = latin for gland
• carcinoma = latin for epithelial cells
• cancer that develops in the glands that line your organs

Question 5

Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as which of the following:

1 - atypical hyperplasia (abnormal hyperplasia)
2 - atypical metaplasia
3 - typical hyperplasia
4 - typical metaplasia

Answer 5

1 - atypical hyperplasia

Question 6

Type 1 endometrial cancer, which are adenocarcinomas (cancer of glandular cells in endometrium) begins as atypical hyperplasia and is driven by the unopposed production of which hormone?

Answer 6

• estrogen

Question 7

The slide below shows type 1 endometrial cancer. What is the defining feature of this image that confirms type 1 endometrial cancer?

Answer 7

• increased cell number
• atypia (loss of normal glandular (appearance)
• increased nucleus size
• increased nuclear to cytoplasm ratio

Question 8

Type 2 endometrial cancers are generally those that are not estrogen dependent. What 5 types of cancers can these be?

Answer 8

• serous (smooth tissue membrane of mesothelium lining)
• clear cell
• mucinous
• squamous
• sarcoma (cancer in connective tissue)

Question 9

Type 2 endometrial cancers are generally those that are not estrogen dependent. They generally occur in which of the following:

1 - hyperplasia endometrium
2 - atrophic endometrium
3 - metaplastic endometrium
4 - dysplastic endometrium

Answer 9

2 - atrophic endometrium

Question 10

Type 2 endometrial cancers are generally those that are not estrogen dependent. Which genetic mutation drives this type of cancer?

Answer 10

• mutation in p53 gene

- tumour suppressing gene doesn’t work so tumour develops

Question 11

The grading of type 2 endometrial cancers, those generally are not estrogen dependent. They can be staged on a level of 1-3. What is the staging based upon?

Answer 11

• how similar tissue is to healthy tissue
• Well differentiated- Grade 1
• Moderately differentiated- Grade 2
• Poorly differentiated- Grade 3

Question 12

If a patient has been confirmed as having endometrial cancer they will generally be referred to a multidisciplinary clinic. What investigations will they need prior to being referred to a multidisciplinary clinic?

1 - ultrasound, MRI, biopsy, histology scoring
2 - blood test, MRI, biopsy, histology scoring
3 - genetic testing, MRI, biopsy, histology scoring
4 - ultrasound, MRI, genetic testing, histology scoring

Answer 12

1 - ultrasound, MRI, biopsy, histology scoring

Question 13

In a patient with stage 1 endometrial cancer, which is considered low risk what would their treatment be?

Answer 13

• total abdominal hysterectomy
• bilateral oophorectomy (removal of ovaries)
• careful pelvic inspection (staging helps identify risk of metastasis)

Question 14

Is stage 1-3 of endometrial cancer, what risk is this considered?

1 - low
2 - intermediate
3 - high
4 - severe

Answer 14

2 - intermediate

Question 15

Is stage 1-3 of endometrial cancer, which is considered intermediate risk, what would the treatment be?

Answer 15

• total abdominal hysterectomy
• lymphadenopathy (crucial for staging)
• radiotherapy
  COULD BE A MIXTURE OF OR ALL OF THESE

Question 16

What are the 3 methods to do for hysterectomy?

Answer 16

1 - laparoscopic
2 - open abdominal
3 - robotics
UTERUS IS REMOVED VAGINALLY THOUGH

Question 17

Cervical cancer incidence is declining, what are the main reasons for this?

Answer 17

• smear screening roll out

- diagnosis is earlier

Question 18

The prevalence of human papillomavirus (HPV) has been reducing between 2008 and now. What is the main reason for this?

Answer 18

• immunisation (ideally prior to exposure to HPV)
• targets HPV strains 16 and 18 using Cervarix
• new HPV vaccine Gardasil targets HPV strains 6, 11, 16 and 18 (changed in 2012)

Question 19

What are the 3 main treatment options for a patient with a confirmed diagnosis of cervical cancer?

Answer 19

• surgery
• chemotherapy
• radiotherapy (local radiation)

Question 20

What cell type is associated with aprox 80% of all cervical cancers?

Answer 20

• squamous cells

Question 21

In staging of cervical cancer (except for very early staging of disease) how is staging of cervical cancer performed?

Answer 21

• cystoscopy (camera into the bladder) as cervical cancer can spread easily
• patient will be anaesthetised
• spread to bladder is important to determine staging and spread

Question 22

What imaging modality is used to assess the parametrium and the pelvic and para-aortic lymph nodes?

Answer 22

• MRI

Question 23

What is the 5 year survival rate of someone with cervical caner?

Answer 23

• 65%

- follow up 6 monthly then annually for 5 years following treatment

Question 24

The 5 year survival rate of someone with cervical caner is 60%. When is recurrence most likely?

Answer 24

• within 3 years

Question 25

Is cervical cancer common in pregnancy?

Answer 25

- no