4 - Uterine Neoplasms Flashcards
most common gyn cancer in US
endometrial
which gyn cancer is most fatal
ovarian
lifetime risk of endometrial CA
3%
key factor in development of endometrial CA
estrogen > more estrogen (unopposed), more risk
risk factors for endometrial CA
age (most important) race - highest incidence in whites, higher mortality in AAs unopposed estrogen exposure (like in estrogen replacement therapy, PCOS) insulin resistance nulliparity family hx obesity tamoxifen
which cancer is most strongly assoc w/ obesity?
endometrial
hereditary cause of endometrial CA
Lynch syndrome
Lynch syndrome - predisposed to what cancers?
colon, ovarian, endometrial, uroepithelial
Amsterdam criteria
to determine if a family is likely to have Lynch syndrome
3 or more relatives w/ assoc CA
2 or more successive generations
1 or more dx before age 50
1 should be first deg relative of other two
FAP should be excluded in those w/ colon cancer
how does endometrial hyperplasia present?
abnl uterine bleeding
types of endometrial hyperplasia and probability of progressing to CA
penny, nickel, dime, quarter simple - 1% complex - 3% simple w/ atypia - 8% complex w/ atypia - 29%
mgmt of endometrial hyperplasia w/ no atypia vs w/ atypia
no atypia:
provera (progesterone), mirena, OCPs, hysterectomy an option if post menopausal
resample q 3-6 mo
atypia:
if they dont want kids, hysterectomy. else, progesterone and mirena and rebiopsy q 3 mo
evaluation of postmenopausal bleeding or irregular vaginal bleeding
NEED endometrial biopsy - don’t just do US
pt w/ abnl bleeding has endometrial biopsy that is negative. next step?
dilatation and curettage - EMB has false neg rate of 10%
type 1 vs 2 endometrial CA - cause, who gets it, histology, prognosis
1 - hyperesterogenism, younger, endometrioid w/ hyperplasia / low grade, good prognosis
2 - not assoc w/ estrogen, older, other histo w/ no hyperplasia and higher grade, poor prognosis
papillary serous endometrial CA - what type #? how is it different?
type 2
spreads more like ovarian CA - may spread outside uterus even w/ minimum invasion
FIGO grades for endometrioid tumors
1 - up to 5% solid
2 - 6-50% solid
3 - >50% solid
relative importance of treatment modalities in endometrial CA
surgery - very important - needed for complete staging. aggressive removal of reproductive structures
adjuvant therapies only used in higher risk pts (histo, age, grade, depth of invasion, stage)
radiation - poor surgical candidates and palliative use mostly. reduces risk of recurrence but does not affect overall survival
chemo - pts w/extremely high risk for recurrence or w/ extrauterine dz
FICO stages for endometrial CA
1 - uterus only
2 - cervix
3 - adnexa, vagina, pelvic/aortic LNs
4 - bladder, bowel, inguinal LN, distant mets
why no screening for endometrial CA?
precursors of type I are symptomatic, and type 2s have no recognized premalignant phase
screening for Lynch patients
annual TV US, EMB, CA125 starting 30-35 yo or 5-10 yrs prior to earliest dx. consider prophylactic surg at 35-40 or when done having kids
colonoscopy at 20-25 yo or 5-10 y before earliest dx
