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23 Cards in this Set
- Front
- Back
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a) What percentage of uterine cancer is non-adenocarcinoma (i.e. sarcoma, carcinosarcoma)?
b) What histologic sites of the uterus are affected?" |
a) 8-10%
b)Myometrium (leimyosarcoma) Endometrium (stroma: ESS, well-diff ES, carcinosarcoma, adenosarcoma) [NOTE: MMMT has been reclassified as an epithelial cancer (carcinoma)]" |
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List the different types of non-epithelial uterine cancer.
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Leiomyosarcoma
Carcinosarcoma (MMMT) Well-diff ES Endometrial stromal sarcoma Adenosarcoma [NOTE: MMMT has been reclassified as a carcinoma (e.g. epithelial)" |
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a) List risk factors for non-adenocarcinoma uterine cancers.
b) List protective factors for the same." |
a)
Pelvic irradiation Black ethnicity (? incr. fibroids) Chronic estrogen exposure b) Smoking OCP use" |
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What is the likelihood of diagnosing uterine sarcomas on pipelle biopsy?
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25-50%
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a) What uterine sarcomas/non-adenocarcinoma tumours fall into aggressive growth patterns?
b) Which have slow, indolent growth patterns?" |
"a) Carcinosarcoma
Undifferentiated ES Leimyosarcoma b) ESS STUMP Adenosarcoma Note: the first group have early LVSI and hematogenous spread and rapid disease progression despite therapy" |
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a) How do leimyosarcomas typically spread: hematogenous or lymphatic?
b) How do carcinosarcomas typically spread: hematogenous or lymphatic?" |
"a) hematogenous - mets to lung most common
b) lymphatic - 30% with clinical stage I disease have positive LN" |
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Describe the staging of leimyosarcoma.
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"Stage I: confined to uterus
A: < 5cm B: > 5cm Stage II: confined to pelvis A: adnexal involvement B: extension to extrauterine pelvic sites Stage III: A: extension to abdominal site B: > 1 extension to abdominal site C: positive nodes Stage IV: A: invades bladder/rectum B: distant mets (inguinal, lung, liver, spleen, etc.)" |
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Describe the staging of Carcinosarcoma.
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Same used as for Epithelial Endometrial cancer.
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Describe staging for adenosarcoma and ESS.
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Stage I: confined to uterus
A: limited to endometrium/endocervix, no myometrial invasion B: <= 50% myometrial invasion C: > 50% myometrial invasion Stage II: confined to pelvis A: adnexal involvement B: extension to extrauterine pelvic sites Stage III: A: extension to abdominal site B: > 1 extension to abdominal site C: positive nodes Stage IV: A: invades bladder/rectum B: distant mets (inguinal, lung, liver, spleen, etc.)" |
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For which uterine sarcoma (non-adenocarcinoma) is nodal dissection at time of surgical treatment/staging required?
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Carcinosarcoma - 30% positive even if clinical stage I disease.
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How many patients after resection of primary uterine sarcoma and surgical stage I will experience relapse if observed only (no adjuvant treatment)?
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50%
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Besides chemotherapy, what medical treatment for ESS might be beneficial?
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Hormones (ER/PR positive)
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List features of leimyosarcoma
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"mean age: 50
fast-growing, aggressive, high rate of relapse and death despite stage at diagnosis typically diagnosed at the time of surgery for benign fibroid disease" |
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Describe common signs and symptoms of Sarcoma of the uterus.
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1. Vaginal bleeding is the most common sign.
2. Many complain of pelvic/abdominal pain. 3. A profuse, foul smelling vaginal discharge is common. 4. Some have GI complaints. 5. Tend to grow quickly so may have increased abdo girth with acute onset. - degenerating fibroids can have similar presentation. |
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What % of uterine sarcomas are leiomyosarcoma, what is the average age at presentation and what percent will present at stage I, II, III or IV?
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- 30-40% of uterine sarcomas
- age 50 Stage I = 50% stage II = 10% Stage III = 10% Stage IV = 20% |
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What is a STUMP tumor?
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Smooth muscle tumor or uncertain malignant potential.
Tumors that can not be diagnosed reliably as malignant or benign based on standard criteria. |
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What is a Malignant Mixed Mullerian Tumor (MMMT) and what is the avg age of presentation?
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MMMT or carcinosarcoma, is a malignant neoplasm that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components.
Ave age is 65 |
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At what stage do women present with MMMT?
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Stage I - 40%
Stage II - 10% Stage III - 25% Stage IV - 25% |
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What are the presenting characteristics of MMMT?
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Grossly it is fleshy (more than adenocarcinoma), bulky necrotic and often fills the endometrial cavity and deeply invades the myometrium.
Classic presentation is a large tumor protrudes through the cervix and fills the vaginal vault. On histology, the tumors consist of adenocarcinoma (endometrioid, serous or clear cell) mixed with the malignant mesenchymal (sarcoma) elements; |
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What are the risk factors for MMMT?
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Risk factors are similar to those of adenocarcinomas and include obesity, exogenous estrogen therapies, and nulliparity.
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Which sarcomas have an aggressive growth pattern?
Which do not? |
leiomyosarcomas
High grade undifferentiated sarcomas MMMTs aggressive growth, early LVSI, early hematogenous spread and rapid disease progression despite treatment. Endometrial stromal sarcomas and adenosarcomas have slow growth with long disease free intervals. |
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What is the highest chance of cure in a sarcoma presentation
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Surgical removal of all the tumor that is confined to the uterus.
no benefit to cytoreductive surgery. |
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What is the treatment for MMMT?
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TAH BSO with LN biopsy (15-20%+ in clinical stage I)
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