Uterine Cancer

Question 1

When do endometrial polyps occur?

Answer 1

around or after menopause

Question 2

What are the 3 types of endometrial hyperplasia?

Answer 2

simple
complex
atypical

Question 3

What defines simple endometrial hyperplasia?

Answer 3

glands + stroma
glands are dilated
normal cytology

Question 4

What defines complex endometrial hyperplasia?

Answer 4

focal distribution
glands are crowded
no stroma
normal cytology

Question 5

What defines atypical endometrial hyperplasia?

Answer 5

focal distribution
glands are crowded
no stroma
abnormal cytology

Question 6

What is the peak age incidence of endometrial carcinoma?

Answer 6

50-60years

Question 7

What predisposes you do endometrial carcinoma?

Answer 7

Lynch syndrome

PCOS

Question 8

How does endometrial carcinoma present?

Answer 8

abnormal bleeding

Question 9

What are the different types of endometrial carcinoma?

Answer 9

both adenocarcinomas:
Endometrioid carcinoma - type 1
Serous and Clear cell - type 2

Question 10

Describe Endometrioid carcinoma - type 1?

Answer 10

related to unopposed oestrogen

associated with atypical hyperplasia

Question 11

What is more common Endometrioid carcinoma - type 1 or Serous and Clear cell - type 2?

Answer 11

Endometrioid carcinoma - type 1 - 80%

Question 12

What are risk factors for Endometrioid carcinoma - type 1?

Answer 12

obesity - adipocytes expresss aromatase that converts androgens -> oestrogen
increase in free insulin levels leads to endometrial proliferation

Question 13

What causes Serous and Clear cell - type 2?

Answer 13

TP53 mutation and over expression

Question 14

What is the precursor lesion for Serous and Clear cell - type 2?

Answer 14

serous endometrial intraepithelial carcinoma

Question 15

How does Serous and Clear cell - type 2 spread?

Answer 15

along the Fallopian tubes mucosa and peritoneal surfaces (so can persent with extra uterine disease)

Question 16

What is more aggressive Endometrioid carcinoma - type 1 or Serous and Clear cell - type 2?

Answer 16

Serous and Clear cell - type 2

Question 17

What is the treatment for endometrial carcinoma?

Answer 17

surgery - total abdominal hysterectomy with bilateral salpingoophrectomy and peritoneal washings (TAH-BSO)
radiotherapy as adjuvant
chemo if high grade

Question 18

How is endometroid carcinoma graded?

Answer 18

grade 1 - 5% or less solid growth
grade 2 - 6-50% solid growth
grade 3 - >50% solid growth (can no longer form glands)

Question 19

What is an endometrial stromal carcinoma?

Answer 19

can be low grade or high grade and resemble endometrial stroma
it can infiltrate the myometrium and lymphovascular system

Question 20

How does endometrial stromal carcinoma present?

Answer 20

abnormal bleeding or metastasis - ovary or lung

Question 21

How do leiomyosarcomas present?

Answer 21

women >50
abnormal vaginal bleeding
palpable pelvic mass
pelvic pain

Question 22

What is the prognosis of leiomyosarcomas?

Answer 22

poor - even if confined

5yr survival 15-25%

Question 23

How do leiomyomas present?

Answer 23

pelvic mass and abnormal uterine bleeding

women >40s

Question 24

What different places can leiomyomas/fibroids present?

Answer 24

submucous
subserous
intracavitary
pedunculated
intramural

Question 25

What medical treatment can be given for fibroids?

Answer 25

mirena GnRH analogues progestins - OCP

Question 26

What surgical treatment can be given for fibroids?

Answer 26

laparotomy/laproscopic

Question 27

What must be done in an acute presentation of a fibroid degeneration?

Answer 27

myomectomy | subtotal or total hysterectomy

Question 28

How does endometriosis present?

Answer 28

severe dysmennorhoea pre menstrual pain dysparenuia

Question 29

What are the consequences of endometriosis?

Answer 29

subfertility ectopic pregnancy cyst formation pain malignancy

Question 30

What is the first line investigation for endometrial cancer?

Answer 30

pipelle biopsy - can do in a GP

Question 31

What is an endometrioma?

Answer 31

endometriosis in the ovary

Question 32

What are endometriotic cysts?

Answer 32

endometrium in the wrong place eg ovary | blood filled cysts

Question 33

What is an adenomyosis?

Answer 33

endometriosis in the myometrium

Question 34

What are the two types of functional cysts?

Answer 34

follicular or luteal - form when ovulation doesnt occur

Question 35

Describe functional cysts?

Answer 35

usually <5cm in diameter asymtomatic and resolve spontaneously may bleed/rupture and cause pain lined by grnaulosa cells