Uterine Malingancy

Question 1

When looking at a pathology report you see that your patient has atypical hyperplasia of the uterus. What specific condition is this a precursor for?

Answer 1

Endometriod carcinoma

Question 2

When looking at a pathology report you see that your patient has serous intraepithelial carcinoma of the uterus. What specific condition is this a precursor for?

Answer 2

Serous carcinoma

Question 3

What condition must you look for in overweight women with PMB?

Answer 3

Endometrial carcinoma

Question 4

Which type of endometrial cancer is associated with unopposed oestrogen?

Answer 4

Endometriod and mucinous

Question 5

Which type of endometrial cancer is not associated with unopposed oestrogen?

Answer 5

Serous and Clear cell

Question 6

Why does obesity increase the risk of endometrial cancer?

Answer 6

Adipocytes express aromatase with converts ovarian androgens into oestrogens which induce endometrial proliferation

Question 7

What syndrome predisposes you to colorectal cancer and ovarian cancer?

Answer 7

Lynch syndrome

Question 8

What mode of inheritence is seen in lynch syndrome?

Answer 8

Autosomal dominant

Question 9

What gene mutation is seen in serous and clear cell cancer of the endometrium?

Answer 9

TP53

Question 10

What is the difference between simple and atypical endometrial hyperplasia?

Answer 10

Simple hyperplasia is usually generalised where as atypical is usually localised

Question 11

Which is more dangerous is endometrial hyperplasia; cytological or architechtural abnormaility?

Answer 11

Cytological. These have a greater malignant potential.

Question 12

What stage is this endometrial cancer; Confined to the uterus with less than 50% of the myometrium being invaded?

Answer 12

Stage 1A

Question 13

What stage is this endometrial cancer; Confined to the uterus with more than 50% of the myometrium being invaded?

Answer 13

1B

Question 14

What stage is this endometrial cancer; Invasion into the cervical stroma?

Answer 14

2

Question 15

What stage is this endometrial cancer; Involvement of pelvic lymph nodes?

Answer 15

3

Question 16

What stage is this endometrial cancer; Invasion into the vagina?

Answer 16

3

Question 17

What stage is this endometrial cancer; Invasion into the serosa of the uterus?

Answer 17

3

Question 18

What stage is this endometrial cancer; Invasion of the bladder?

Answer 18

4

Question 19

What stage is this endometrial cancer; Invasion of the rectum?

Answer 19

4

Question 20

What stage is this endometrial cancer; brain mets?

Answer 20

4

Question 21

What is the peak incidence of endometrial carcinoma?

Answer 21

50 - 60 years

Question 22

What type of uterine cancer is atypical hyperplasia a precursor for?

Answer 22

Endometriod

Question 23

What type of cancer is serous intraepithelial carcinoma a precursor for?

Answer 23

Serous carcinoma

Question 24

How does endometrial carcinoma generally present?

Answer 24

Abnormal bleeding

Question 25

How are endometriod carcinoma generally graded?

Answer 25

By their architechture Grade 1: 5% or less solid growth Grade 2: 6 - 50% solid growth Grade 3: Over 50% solid growth

Question 26

What is the most common presentation of endometrial stromal sarcoma?

Answer 26

Abnormal uterine bleeding | But can also present with metastases

Question 27

Which endometrial tumour is a mixture of epithelial and mesenchymal components?

Answer 27

Carcinosarcoma

Question 28

What name is given to a malignant tumour of smooth muscle?

Answer 28

Leiomyosarcoma

Question 29

What is the most common type of endometrial carcinoma?

Answer 29

Endometriod carcinoma

Question 30

What grade is this endometrial cancer: Well differentiated lesions with 98% glandular formations

Answer 30

Grade 1

Question 31

What grade is this endometrial cancer: 48% solid areas

Answer 31

Grade 2

Question 32

What grade is this endometrial cancer: More than 50% solid lesions

Answer 32

Grade 3

Question 33

What is the best imaging modality for assessing the degree of myometrial invasion in endometrial cancer?

Answer 33

MRI

Question 34

Describe simple uterine hyperplasia

Answer 34

Glands of various sizes, most cystic No crowding of glands Small mitotic figures

Question 35

Describe complex uterine hyperplasia

Answer 35

Crowding of glands Stratified epithelium with more mitotic figures No atypia

Question 36

Describe atypical uterine hyperplasia

Answer 36

Nuclear atypia is present Abnormal mitotic figures Glandular polypoid formations

Question 37

How is simple uterine hyperplasia treated?

Answer 37

No routine follow up | If patients are symptomatic progesterone agents might help wither orally or via the mierna IUS

Question 38

What is the risk of progression to endometrial cancer if you have simple uterine hyperplasia?

Answer 38

1%

Question 39

How is complex uterine hyperplasia treated?

Answer 39

Progesterone therapy with mirena coil

Question 40

What is the risk of progression to endometrial cancer if you have atypical uterine hyperplasia?

Answer 40

20 - 50%

Question 41

How is atypical uterine hyperplasia treated?

Answer 41

Hysterectomy with bilateral salpingo oophrectomy