Uterine Cancer

Question 1

What are the causes of dysfunctional uterine bleeding?

Answer 1

• endometrial polyps

- endometrial hyperplasia (simple, complex, atypical)

Question 2

What are endometrial polyps?

Answer 2

benign outgrowth of the glands and stroma which undergo the same cyclical changes as the endometrium

Question 3

What can be a potential cause of endometrial hyperplasia?

Answer 3

persistent oestrogen stimulation (HRT, PCOS)

Question 4

What are the histological features of simple hyperplasia?

Answer 4

glands that are cystically dilated because they continue to grow

Question 5

When would simple hyperplasia commonly occur?

Answer 5

Around menopause because the glands continue to grow due to low levels of oestrogen

Question 6

What are the histological features of complex atypical hyperplasia?

Answer 6

• darker nuclei

- rounder cells

Question 7

At what age does endometrial cancer usually occur?

Answer 7

50-60. <40 is rare

Question 8

What underlying predisposition could be a cause of endometrial cancer in younger women?

Answer 8

• PCOS

- Lynch syndrome

Question 9

What are the two main types of endometrial cancer?

Answer 9

type 1 tumours-endometrioid (and mucinous) carcinoma
type 2 tumours-serous carcinoma (and clear cell)
carcinoma

Question 10

What are the features of endometrial carcinoma?

Answer 10

macroscopic: large uterus
microscopic: most are adenocarcinomas (from glands)
spread: directly into myometrium/cervix, lymphatics, haematogenous

Question 11

How does endometrial cancer usually present?

Answer 11

-abnormal bleeding

Question 12

What are the features of endometrioid carcinoma?

Answer 12

• related to unopposed oestrogen
• associated with atypical hyerplasia
• good prognosis, usually limited to the uterus at presentation

Question 13

What are the features of serous carcinoma?

Answer 13

• NOT due to unopposed oestrogen
• affect elderly post-menopausal women
• TP53 often mutated
• due to microsatellite instability (germline mutation of mismatch repair genes-lynch syndrome)
• spreads along fallopian tube mucosa and peritoneal surfaces
• more aggressive than endometrioid ca

Question 14

What are the risk factors for endometrial cancer?

Answer 14

• obesity

- lynch syndrome

Question 15

How does obesity increase the risk of endometrial cancer?

Answer 15

• endocrine and inflammatory effects of adipose tissue
• adipocytes convert ovarian androgens into oestrogens which induce uterine proliferation
• sex hormone binding globulin reduced in obese women so free, biologically active hormone is higher
• insulin binding globulin reduced so free insulin levels are higher. insulin and insulin-like growth factor causes endometrium to proliferate

Question 16

What is lynch syndrome (hereditary non-polyposis colorectal cancer)?

Answer 16

-it is a cancer predisposition syndrome which increases risk of colorectal cancer, endometrial and
ovarian caner

Question 17

How can lynch syndrome be determined as the cause of cancer?

Answer 17

• immunohistochemistry staining of tumour for mismatch repair proteins
• tumours may show microsatellite instability (characteristic of defective mismatch repair)

Question 18

What are the histological features of serous carcinoma?

Answer 18

-complex papillary/glandular architecture with diffuse, marked nuclear pleomorphism

Question 19

What is the treatment for endometrial cancer?

Answer 19

• hysterectomy if tumour has not breached serosa (perimetrium)
• chemotherapy
• radiotherapy

Question 20

What is endometrial stromal sarcoma

Answer 20

• rare form of endometrial cancer
• cells resemble stromal cells
• often infiltrate myometrium and lymphovascular space

Question 21

How does endometrial stromal sarcoma usually present?

Answer 21

• abnormal uterine bleeding

- usually symptoms of metastasis (ovary/lung)

Question 22

What is endometrial carcinosarcoma?

Answer 22

• high grade carcinomatous and sarcomatous element

- commonly occur in older women

Question 23

What is a common feature in endometrial carcinosarcoma?

Answer 23

-heterologous elements (rhabdomyosarcoma, chondrosarcoma, osteosarcoma)

Question 24

What is the prognosis of endometrial carcinosarcoma?

Answer 24

poor outcome

Question 25

What are common abnormalities affecting the myometrium?

Answer 25

• leiomyoma (common)

- leiomyosarcoma (rare)

Question 26

What is leiomyoma usually associated with?

Answer 26

• menorrhagia

- infertility

Question 27

What is leiomyosarcoma?

Answer 27

-malignant smooth muscle tumour displaying spindle cell morphology

Question 28

What is the age at which leiomyosarcoma usually occurs?

Answer 28

women >50 years old (poor prognosis even if tumour confined to uterus)