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RE > Pathology of the Female Reproductive Tract Part 3 > Flashcards

Pathology of the Female Reproductive Tract Part 3 Flashcards

1
Q

Where do most uterine cancers arise from?

A

the endometrium

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2
Q

Uterine cancer is the — most common cancer worldwide for female patients and the —- most common overall

A
  • 6th
  • 14th
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3
Q

Rising incidence of endometrial cancer is related to its risk factors:

A
  • related to unopposed oestrogen exposure
  • menopause: reflects increased neoplastic
    risks of ageing process, max time uterus
    has been exposed to oestrogen
  • low socioeconomic status: correlated with
    obesity, wider determinants of health
  • increasing rates of obesity: adipose tissues
    synthesizes and stores oestrogen in
    adipose cells through the process of
    aromatization of androgens to oestrogen.
    associated with PCOS
  • endometrial hyperplasia with atypia
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4
Q

Endometrial Cancer: Investigations:

A
  • Transvaginal USS (TVS):
    - looking at endometrial thickness
    - greater than or equal to 4mm ->
    further investigations
    - if <4mm + no irregularity, no further
    investigations
  • Endometrial Biopsy:
    - for pre and perimenopausal patients,
    in association with a hysteroscopy
  • Hysteroscopy:
    - if biopsy negative but symptoms
    persist
    - if biopsy not possible or USS
    irregularities
    - direct visualisation of endometrial
    cavity and endometrium
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5
Q

Stages: Names:

A

1A,B,C,
etc to 4C

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6
Q

Staging for endometrial cancer:

A

insert slide

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7
Q

Stage 1 endometrial cancers are most low risk and are treated with

A

TAHBSO and pelvic staging

if evidence of high grade tumours = intermediate risk

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8
Q

Endometrial Cancers: Intermediate and High Risk: Treatment:

A
  • if evidence of high grade in stage 1
  • if stage 2 onwards
  • combination of surgery,
    chemo/radiotherapy
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9
Q

Which age group does cervical cancer mainly affect?

A

30 to 45 years old

2nd most common cancer within this age range

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10
Q

What % of cervical cancers are caused by HPV?

A
  • almost all
  • 79% due to HPV 16 and 18
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11
Q

The decrease in incidence of cervical cancer cases across all age groups is attributed to?

A
  • HPV vaccine in younger ages
  • screening education in older ages
  • association with deprivation
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12
Q

Assessment of Cervical Cancers:

A
  • most are picked up through screening
    program
  • symptoms are often subtle: minor
    postcoital bleeding, post menopausal
    bleeding, abnormal vaginal discharge,
    dyspareunia
  • perform pelvic exam with speculum, if
    cervix looks normal, perfom smear
  • if cervix has visible lesion then refer to
    colposcopy for biopsy
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13
Q

Cervical Cancers: Investigations:

A
  • vaginal examination, cervix visualisation,
    rectal examination (metastases)
  • MRI is most accurate for staging and pre-
    treatment planning
  • CXR required
  • PET and sentinel node biopsy for some
  • ***HPV and p16 testing
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14
Q

Cervical Cancer: Staging:

A

insert table

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15
Q

Cervical Cancer: Treatment:

A
  • 1A: loop excision of transformation zone ->
    cervical incompetence likely -> implications
    for pregnancy
  • 1A2-B2: radical hysterctomy + bilateral
    salpingectomy
  • 1AB3-4A: chemotherapy (cisplatin)
  • 4B: depends on spread, clinical condition,
    palliation
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16
Q

What is a carcinoma?

A
  • neoplasms
  • form solid tumours
    -from epithelial lines
  • 80-90% cancer diagnoses
17
Q

Morphological subtypes of endometrial carcinomas:

A
  • Type 1 and types 2
18
Q

Type 1 Endometrial Carcinomas:
- age?
- common or rare?
- staging of tumours?
- associated with

A
  • younger patients: peri/postmenopause
  • most common
  • associated with:
    - hyperplasia and atypia
    - Lynch syndrome
    - mutations of PTEN and KRAS
19
Q

Type 2 Endometrial Carcinomas:

A
  • older: postmenopause
  • least common
  • carcinomas of other origins
  • high grade tumour + aggressive
  • non-oestrogen dependent: serous, clear
    cell, mixed
  • associated with serous endometrial
    intraepithelial carcinoma and mutations of
    TP53
20
Q

Molecular Subtypes of Endometrial Carcinomas:

A
  • Ultramutated: POLE, DNA polymerase
    mutations
  • Hypermutated: microsatellite mutations
  • Copy Number Low and Microsatellite
    Stable: PI3K/AKT pathway mutations
  • Copy Number High/Aggressive Tumours:
    TP53 mutations
21
Q

What is the most common types of carcinoma in the cervix?
Which age range is affected most commonly?

A
  • squamous cell carcinoma
  • 30-45 years
22
Q

Cervical Carcinomas: Risk Factors:

A
  • associated with HPV, especially 16 and 18
  • precursors are CIN 1,2,3
  • p16 over expression
  • p53 mutations
23
Q

Where do most cervical cancers occur?

A

atypical squamous epithelium invades the stroma of the cervix usually at the transformation zone

can be keratinising or non-keratinsing

24
Q

Morphological subtypes of squamous cell carcinomas of the cervix are

A
  • keratinising
  • non-keratinising
25
Q

Molecular Subtypes of Squamous Cell Carcinomas of the Cervix:

A
  • SCC Keratin-high
  • SCC Kerating-low
  • Adenocarcinoma
26
Q

What classifies invasive carcinomas?

A
  • breaching the basement membrane and
    invading the stroma
27
Q

A 57 year old patient presents with a 3 month history of postmenopausal bleeding. She is known to have Lynch Syndrome.

What is the most likely diagnosis??

A
  • Endometriod Type 1; adenocarcinoma of
    the endometrium
28
Q

What screening should a patient with Lynch syndrome be receiving?

A
  • annual screening
  • TVS, hysteroscopy/endometrial sampling
    >35
29
Q

A 32 year old patient presents to their GP with postcoital bleeding and dyspareunia for 3 months. They have never had a smear test.

What is the most likely diagnosis?

A
  • CIN or squamous carcinoma of the cervix
30
Q

A 32 year old patient presents to their GP with postcoital bleeding and dyspareunia for 3 months. They have never had a smear test.

  • CIN or squamous carcinoma of the cervix

What would you do next for the patient?

A
  • full history and examination on
    presentation
  • if no lesion visible, smear test
  • if lesion visible, colposopy clinic for biopsy

**HPV testing is another appropriate test

31
Q

What is Lynch Syndrome?

A

Genetic predisposition to multiple cancers including colorectal, endometrial and ovarian cancers

RE (52 decks)

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