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Reproduction and Sexual Health > Uterine Malignancy > Flashcards

Uterine Malignancy Flashcards

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1
Q

What are the 2 non-cancerous causes of dysfunctional uterine bleeding?

A
  • Endometrial polyps

* Endometrial hyperplasia

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2
Q

Endometrial polyps are rare

A

FALSE- they are very common

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3
Q

When, in a woman’s life, are polyps most common?

A

Occur around the time of menopause and after menopause

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4
Q

What are the 3 different categories of endometrial hyperplasia?

A
  • Simple
  • Complex
  • Atypical (precursor of carcinoma)
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5
Q

What is the cause of endometrial hyperplasia?

A

Cause is often unknown, but may be due to persistent oestrogen stimulation

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6
Q

Describe simple endometrial hyperplasia.

A

General which affects the entire endometrium, as they glands grow they become cystic

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7
Q

Describe complex endometrial hyperplasia

A

Usually focal and only affects part of the endometrium

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8
Q

If cells of endometrial hyperplasia are atypical, what can they also be said to be?

A

Complex + pre malignant

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9
Q

Why can hyperplasia look like ‘swiss cheese’ on histology?

A

Due to lots of cystic dilatations

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10
Q

In simple hyperplasia glands are cystically dilated because they continue to grow, why is this?

A

Common around the time on the menopause, if a woman doesn’t ovulate every months, she contines to secrete low levels of oestrogen which causes these glands to grow

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11
Q

Describe the histological appearance of complex atypical hyperplasia.

A

Glands are crowded

Cytology is atypical – cells are round instead of cigar-shaped, and they lose polarity in that nuclei don’t sit on the BM, but are higher up in the cells

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12
Q

When is the peak incidence of endometrial carcinoma?

A

Peak incidence in 50-60 year olds, uncommon in anyone under 40

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13
Q

Under what age is endometrial carcinoma uncommon?

A

Under 40 years

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14
Q

In a young woman (under 40 years) with endometrial carcinoma, what should you consider?

A

In young women, consider underlying predisposition e.g. polycystic ovary syndrome or Lynch syndrome

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15
Q

What are the 2 main groups of precursor lesions for endometrial carcinoma?

A
  • Endometrioid carcinoma – precursor atypical hyperplasia

* Serous carcinoma – precursor serous intraepithelial carcinoma

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16
Q

How does endometrial cancer present?

A

Abnormal bleeding

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17
Q

Describe the macroscopic appearance of endometrial cancer.

A
  • Large uterus

* Polypoid

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18
Q

Describe the microscopic appearance of endometrial cancer.

A
  • Most are adenocarcinomas

* Most are well differentiated

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19
Q

Describe the spread of endometrial cancer.

A
  • Directly into myometrium and cervix
  • Lymphatic
  • Haemotogenous
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20
Q

What are the 2 main clinical types of endometrial cancer.

A
  1. Endometrioid and Mucinous

2. Serous and Clear cell

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21
Q

What % of all endometrial cancers does ‘endometriosis and mucinous’ account for?

A

80%

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22
Q

What are ‘endometriosis and mucinous’ endometrial cancers related to?

A

Unopposed oestrogen

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23
Q

‘endometriosis and mucinous’ endometrial cancers are associated with ….

A

Endometrial hyperplasia

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24
Q

List 3 common gene mutations found in patients with ‘endometriosis and mucinous’ endometrial cancers?

A
  1. PTEN
  2. KRAS
  3. PIK3CA
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25
Microsatellite instability is seen histologically in which cancer?
'endometriosis and mucinous' endometrial cancers
26
Who does serous and clear cell endometrial cancer affect?
Affect elderly post‐menopausal women
27
What type of endometrial cancer is very rare?
Clear cell
28
What gene mutation is often found in women with serous and clear cell endometrial cancer?
TP53 often mutated
29
Describe the spread of serous and clear cell endometrial cancer?
Spreads along Fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease  can spread to peritoneal cavity
30
Describe the spread of serous and clear cell endometrial cancer?
Spreads along Fallopian tube mucosa and peritoneal surfaces so can present with extrauterine disease Can spread to peritoneal cavity !!
31
Serous and clear cell endometrial cancer is more aggressive than endometrioid
TRUE
32
Precursor lesion  serous endometrial intraepithelial carcinoma
Serous and Clear Cell
33
Outline the treatment for endometrial cancer.
Surgery – more extensive + Chemo/Radiotherapy
34
'A complex papillary +/or glandular architecture with diffuse, marked nuclear pleomorphism'. What does this describe?
Serous carcinoma
35
Obesity is a known risk factor for ___________ cancer
Endometrial
36
Why does being obese increase your risk of endometrial cancer?
This excess risk is associated with the endocrine and inflammatory effects of adipose tissue Adipocytes express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation
37
What do adiopocytes express?
Aromatase
38
What does aromatase do?
Converts androgens to oestrogen
39
Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher
True
40
Insulin action is altered in obese women. Explain this.
* Level of insulin-binding globulins is reduced * Free insulin levels are elevated * Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium
41
What is Lynch syndrome?
Hereditary non-polyposis colorectal cancer i.e a cancer predisposition syndrome
42
What are women with Lynch syndrome more likely to present with?
Endometrial cancer
43
Having Lynch syndrome puts you at an increased risk of what cancers?
* Colorectal cancer * Endometrial cancer * Ovarian cancer (increased risk)
44
Why does Lynch syndrome increase your risk of cancer?
Due to the inheritance of a defective DNA mismatch repair gene
45
What is the inheritance pattern of Lynch syndrome?
Autosomal dominant
46
How is Lynch syndrome diagnosed?
Testing cancer tissue for MSI (microsatellite instability)
47
What is MSI?
* A characteristic of defective mismatch repair | * Shown by Lynch cell tumours
48
Where does endometrial carcinoma typically infiltrate?
Myometrium
49
Outline the grading of endometrioid carcinoma.
* Grade 1 – 5% or less solid growth * Grade 2 – 6-50% solid growth * Grade 3 - >50% solid growth
50
What is a carcinosarcoma?
A mixed tumour with malignant epithelial and stromal elements
51
What is a carcinosarcoma also known as?
Malignant mixed Mullerian tumour
52
What is the prognosis of a carcinosarcoma like?
Poor
53
What is the presentation of an endometrial stromal sarcoma?
Abnormal uterine bleeding
54
Where does an endometrial stromal sarcoma usually met to?
Ovary or lung
55
Where does an endometrial stromal sarcoma usually met to?
Ovary or lung
56
Where do endometrial stromal sarcomas usually infiltrate?
Infiltrate myometrium and often lymphovascular spaces
57
Describe a high grade endometrial stromal sarcoma.
It had increased atypia and proliferative activity - more serious
58
What % of all uterine malignancies does a carcinosarcoma account for?
<5%
59
What do 50% of carcinosarcomas have?
Heterologous elements – rhabdomyosarcoma, chrondrosarcoma, osteosarcoma
60
The carcinosarcomas with the worst prognosis are the ones with?
Rhabdomyosarcomatous component
61
Name the 2 types of myocetrial (smooth muscle) tumour of the uterus.
* Leiomyoma (fibroids) | * Leiomyosarcoma (rare)
62
Name the 2 types of myometrial (smooth muscle) tumour of the uterus.
* Leiomyoma (fibroids) | * Leiomyosarcoma (rare)
63
Menorrhagia + Infertility is associated with?
Myometrial pathology
64
What is a Leiomyosarcoma?
A malignant smooth muscle tumour, commonly displaying a spindle cell morphology
65
The most common uterine sarcoma is a?
Leiomyosarcoma
66
What women get Leiomyosarcoma?
Women over 50 years
67
What are the symptoms of a Leiomyosarcoma?
* Abnormal vaginal bleeding * Palpable pelvic mass * Pelvic pain
68
What is the prognosis of a Leiomyosarcoma like?
POOR prognosis even if this is confined to the uterus

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