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24 Cards in this Set
- Front
- Back
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How does endometrial hyperplasia present?
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Abnormal bleeding (w/ some anovulatory cycles)
Occurs in perimenopausal women NONINVASIVE, NONPATHOLOGICAL endometrial proliferation |
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What causes endometrial hyperplasia?
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1) UNOPPOSED ESTROGEN
2) Tamoxifen (estrogen agonist) Risk factors include obesity, hypertension, diabetes, PCOD Protective factor: Progesterone, increased # of birhts. |
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What are the 4 types of endometrial hyperplasia?
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1-2) Simple and Complex hyperplasia w/o atypia
3-4) Simple and complex hyperplasia w/ atypia. RARE to see SIMPLE W/ ATYPIA. |
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What is the difference between simple and complex hyperplasia?
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Complex hyperplasia has much less stroma in between glands.
MANY MORE GLANDS TOO! |
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What is the importance of atypia?
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More important prognostic factor for cancer risk (more important than simple/complex classification)
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What defines atypia?
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Loss of nuclear polarity. Borders lost. Enlarged nuclei with coarse chromatin.
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How much does a hysterectomy reduce the risk of cancer AFTER a diagnosis of complex hyperplasia with atypia?
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NO REDUCTION!
Patients already likely have carcinoma before hysterectomy. |
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What are the three criteria for endometrial carcinoma diagnosis
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1) Irregular infiltration of glands associated with altered fibroblastic stroma (stroma becoming spindly)
2) NO Stroma between "cribiform" glands 3) Glands turn inside out with extensive papillary growth pattern. |
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TRUE/FALSE
All endometrial carcinomas are estrogen-dependent? |
FALSE!
Only Type I's, which account for ~80%. Type II's are only 15-20% and are not |
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What are the differences between Type I and Type II endometrial carcinoma?
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Type I: Low-grade tumor. UNOPPOSED ESTROGEN. Pre-and-peri-menopausal women. MINIMAL MYOMETRIAL INVASION. Indolent
Type II: clear cell, serous. Aggressive. NOT ESTROGEN DEPENDENT. Postmenopausal. |
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What has a malignant cancer invaded that a hyperplasia has not?
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MYOMETRIUM.
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What does Type 1 look like?
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Glands and tumor cells are similar to those of atypical hyperplasia of endometrium (precursos lesion)...still looks somewhat glandular
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What does Type 2 look like.
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Complex papillae and IRREGULAR GAPING GLANDS. Glands turned inside out. Marked nuclear atypia.
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What is the precursor to a TYPE II endometrial carcinoma?
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Intraepithelial carcinoma.
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What are the 4 stages of endometrial carcinoma?
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Stage 1: Confined to uterus
Stage 2: Spread to cervix Stage 3: Spread to uterine serosa, adnexa, LN metastases Stage 4: Distant spread. Bowel/bladder involvement. |
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What are prognosis for treatment?
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75-80% total.
90% if lesion is localized. |
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What is the MAIN cancer type in cervical cancer?
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Squamous cell (>90%). HPV is the strongest risk factor.
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What are the two HPV types MOST ASSOCIATED w cancer.
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Oncogenic types: 16 (squamous) & 18 (adenocarcinoma)
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TRUE/FALSE
The HPV strains that cause genital works have a high oncogenic capacity? |
FALSE!
HPV strains that cause gential warts are likely strain 6 or 11. THESE ARE NOT ONCOGENIC. |
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How do you screen for HPV?
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Pap smear
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What is the mechanism of action of HPV?
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Integrates into host DNA. Peristence is necessary but not sufficient to survival.
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Is flow from normal to low grade to high grade lesion only UNIDIRECTIONAL?
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No!
Low-grade lesions can resolve to normal. High-grade lesions can resolve to low-grade lesions, though the rate of transformation from low to high grade is HIGHER than regression of high to low grade |
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Where is the first site of neoplastic lesions in cervical cancer?
HINT: also the first place to do PAP smear |
SQUAMOCOLUMNAR JUNCTION!
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What is the 2nd leading cause of death in women 20-39?
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CERVICAL CANCER.
Affects underserved countries more. WORLDWIDE is 2nd most lethal cancer. |
