Uterine Cancer

Question 1

When are endometrial polyps common?

Answer 1

Around/After menopause

Question 2

What is atypical endometrial hyperplasia?

Answer 2

Precursor of carcinoma

Question 3

In terms of Dilation, Component, Glands and Cytology, describe simple endometrial hyperplasia

Answer 3

General
Glands + Stroma
Dilated not crowded
Normal

Question 4

In terms of Dilation, Component, Glands and Cytology, describe complex endometrial hyperplasia

Answer 4

Focal
Glands
Crowded
Normal

Question 5

In terms of Dilation, Component, Glands and Cytology, describe atypical endometrial hyperplasia

Answer 5

Focal
Glands
Crowded
Atypical

Question 6

When does endometrial carciinoma usually occur?

Answer 6

50-60 years

Uncommon under 40

Question 7

What should be considered in younger women?

Answer 7

Underlying predisposition e.g. PCOS or Lynch syndrome

Question 8

What is endometrioid carcinoma associated with?

Answer 8

Precursor atypical hyperplasia

Question 9

What is serous carcinoma associated with?

Answer 9

Precursor serous intraepithelial carcinoma

Question 10

What do carcinomas usually present with?

Answer 10

Abnormal bleeding

Question 11

What is seen macroscopically in endometrial carcinoma?

Answer 11

Large uterus

Polypoid

Question 12

What is seen microscopically in endometrial carcinomas?

Answer 12

Most are adenocarcinomas

Most are well differentiated

Question 13

What spread is assoc. with endometrial carcinoma?

Answer 13

Directly into myometrium and cervix
Lymphatic
Haematogenous

Question 14

What are type 1 endometrial carcinoma tumours?

Answer 14

Endometrioid (and mucinous)

Question 15

What are type 1 tumours assoc. with?

Answer 15

Related to unopposed oestrogen

Atypical hyperplasia

Question 16

What are type 2 endometrial carcinoma tumours?

Answer 16

Serous (and clear cell)

Question 17

What are type 2 tumours assoc. with?

Answer 17

Elderly post-menopausal women
TP53 often mutated
Not with unopposed oestrogen

Question 18

What 3 mutations are often seen in type 1 tumours?

Answer 18

PTEN
KRAS
PIK3CA

Question 19

What is Lynch syndrome?

Answer 19

Germline mutation of mismatch repair genes
Hereditary non-polyposius colorectal cancer)
Auto dominance

Question 20

What is a major risk factor for endometrial cancer?

Answer 20

Obesity

Question 21

Why is obesity a risk factor for endometrial cancer?

Answer 21

Adipocytes express aromatase that converts ovarian adrogens into oestrogens which induce endometrial proliferation

Question 22

What is lower in obese women?

Answer 22

Sex hormone-binding globulin

Question 23

What other hormone exerts proliferative effects upon the endometrium?

Answer 23

Insulin

Insulin like growth factor (IGF)

Question 24

How do type 2 tumours spread?

Answer 24

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

Question 25

How is serous carcinoma characterised?

Answer 25

Complex papillary and/or glandular architecture with diffuse, marked nuclear polymorphism

Question 26

Where does endometrial carcinoma usually infiltrate?

Answer 26

Myomerium

Question 27

Where may endometrial carcinoma spread early to?

Answer 27

Peritoneal cavity

Question 28

What does the prognosis of endometrial cancer depend on?

Answer 28

Stage Histological grade Depth of myometrial invasion

Question 29

What is the treatment for endometrial carcinoma?

Answer 29

Hysterectomy | Chemo/radiotherapy

Question 30

What are stage 1, and stage 1Aand 1B endometrial carcinomas?

Answer 30

Stage 1 is confined to the uterus 1A = <50% myometrial invasion 1B = >50%

Question 31

What is stage 2 endometrial carcinoma?

Answer 31

Tumour invades cervical stoma

Question 32

What is stage 3, 3A, 3B and 3C endometrial carcinoma?

Answer 32

Local or regional tumour spread 3A = invades serosa of uterus and/or adnexae 3B = vaginal and/or parametrial involvement 3C = Mets to pelvic and/or para-aortic lymph nodes

Question 33

What is stage 4 endometrial cancer?

Answer 33

Invades bladder and/or bowel mucosa (IVA) and/or distant mets (IVB)

Question 34

Where does an endometrial stromal sarcoma arise from?

Answer 34

Endometrial stroma

Question 35

What is a carcinosarcoma?

Answer 35

Mixed tumour with malignant epithelial and stromal elements

Question 36

What means a carcinosarcoma has the worst possible prognosis?

Answer 36

Rhabdomyosarcomatous component

Question 37

Name a fibroid smooth muscle tumour of the myometrium and it's associations?

Answer 37

Leiomyoma | Mennorhagia and infertility

Question 38

Name a rarer myometrial smooth muscle tumour?

Answer 38

Leiomyosarcoma

Question 39

What does a Leiomyosarcoma display?

Answer 39

Spindle cell morphology

Question 40

When does a leiomyosarcoma occur?

Answer 40

Women >50 years

Question 41

What are common symptoms for leiomyosarcoma?

Answer 41

Abnormal vaginal bleeding Palpable pelvic mass Pelvic pain

Question 42

What is the 5 year survival rate for leiomyosarcoma?

Answer 42

15-25%