Background Flashcards
What is the incidence of endometrial cancer in the United States?
Endometrial cancer is the most common gyn malignancy in the United States, with an incidence of ∼44,000 cases/yr annually. It is the 2nd most common cause of gyn cancer deaths.
What are the 2 forms of endometrial cancer?
Forms of endometrial cancer:
Type I: endometrioid, 70%–80% of cases, estrogen related
Type II: nonendometrioid, typically papillary serous or clear cell, high grade, not estrogen related, aggressive clinical course
What are the The Cancer Genome Atlas molecular categories of endometrial cancer?
POLE (ultramutated)
Micro-satellite instability (MSI) (hypermutated)
Copy-number low (endometrioid)
Copy-number high (Serous-like)
What are the risk factors for endometrial cancer?
Risk factors for endometrial cancer:
Exogenous unopposed estrogen
Endogenous estrogen (obesity, functional ovarian tumors, late menopause, nulliparity, chronic anovulation/polycystic ovarian syndrome)
Tamoxifen
Advancing age (75% postmenopausal)
Hereditary (HNPCC); 27%–71% lifetime risk of endometrial cancer (Barrow E et al., Clin Genet 2009)
Family Hx
HTN
What are protective factors for endometrial cancer?
Protective factors for endometrial cancer include combination oral contraceptives and physical activity.
What is the most common clinical presentation of endometrial cancer?
Endometrial cancer presents with abnl vaginal bleeding in 90% cases.
What % of postmenopausal women with abnl vaginal bleeding have endometrial cancer?
Only 5%–20% of postmenopausal women with abnl vaginal bleeding have endometrial cancer.
What are the 3 layers of the uterine wall?
The 3 layers of the uterine wall are the endometrium, myometrium, and serosa.
What is the primary lymphatic drainage of the uterus?
The primary lymphatic drainage of the cervix and lower uterine segment is to the pelvic LNs (parametrial, internal and external iliacs, obturator, common iliac, presacral). The fundus has direct drainage to the para-aortic nodes. The round ligament can drain directly to the inguinal nodes.
What % of endometrial cancer pts with positive pelvic LNs will also harbor Dz in the P-A LNs? What is the chance of P-A nodal involvement if pelvic nodes are negative?
33%–50% of pts with pelvic LN involvement also have involvement of the P-A nodes. Isolated P-A nodal involvement with negative pelvic LNs is detected in ∼1% of surgically staged cases, though the rate may be higher when dissection is extended above the IMA to the perirenal nodes, especially on the left where direct route of spread might occur.
What determines the grade of endometrial tumors?
The grade of endometrial tumors depends on the glandular component:
Grade I: ≤5% nonsquamous solid growth pattern
Grade II: 6%–50% nonsquamous solid growth pattern
Grade III: >50% nonsquamous solid growth pattern
What is the risk of LN involvement by DOI and grade per Gynecologic Oncology Group’s GOG 33?
According to GOG 33, the risk of LN involvement is <5% for tumors limited to the endometrium (all grades) and 5%–10% for tumors invading the inner and middle 3rd of the myometrium (all grades). For tumors invading the outer 3rd of the myometrium, the risk is 10% for grade 1, 20% for grade 2, and 35% for grade 3. Note: imaging of Pelvis was not obtained in these pts. (Creasman WT et al., Cancer 1987)
What % of pts with +LVSI had Pelvic and P-A node involvement in GOG 33?
In pts with +LVSI, 27% had +pelvic LNs and 19% had +P-A LNs.
What are the most aggressive histologies of epithelial endometrial cancer?
The most aggressive histologies of endometrial cancer are serous, clear cell, and squamous cell variants (i.e., Adenosquamous).
What % of endometrial cancers are adenocarcinomas?
75%–80% of endometrial cancers are adenocarcinomas.
