Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endometrial Cancer > Background and recommendations > Flashcards

Background and recommendations Flashcards

1
Q

What are the unfavorable histologies of endometrial cancer?

A

Papillary serous and clear cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

FIGO Stage I

A

IA: Tumor localized to endometrium or invades less than one-half of the myometrium IB: Tumor localized to endometrium one-half or more of the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

FIGO Stage II

A

Tumor invades stromal connective tissue of the cervix but does not extend beyond uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

FIGO IIIA

A

Tumor involves serosa and/or adnexa (direct extension or metastasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

FIGO Stage IIIB

A

Vaginal involvement (direct extension or metastasis)

parametrial invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FIGO IIIC

A
  1. Regional pelvic nodal disease 2. Regional paraaortic nodal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FIGO Stage IVA

A

Tumor invades bladder mucosa and/or bowel mucosa (bullous edema does not qualify)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stage IVB

A

Distant metastasis including metastasis to inguinal nodes, intraperitoneal disease, lung, liver or bone. (Excludes paraaortic lymph nodes, vagina, pelvic serosa or adexa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AJCC Nodal stage to FIGO

A

N1: IIIC1

N2: IIIC2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AJCC T stage to FIGO

A

T1a and T1b: FIGO IA and IB

T2: FIGO II

T3a and T3B: FIGO IIIA and IIIB

T4: FIGO IVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the poor prognostic signs?

A

High grade 2-3 Cervix involvement LVSI Age > 60 Deep myometrial invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What did the creasman data show is the risk for nodes if you have Deep 1/3rd endometrial wall invasion and you are Grade 1,2,3?

A

G1: 6%

G2: 14%

G3: 23%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the risk for pelvic and paraaortic nodes with Stage II disease?

A

Pelvic: 30%

Paraaortic: 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What imaging and labs are needed at diagnosis?

A

Imaging:

Transvaginal US

CXR

CT scan of abdomen and pelvis

Labs: CBC, BMP, LFTs, CA-125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What special studies are needed for advanced cases?

A

Cystoscopy and sigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you treat Stage IA Grade 1-2 disease?

A

Extrafascial hysterectomy

Peritoneal cytology

Pelvic and paraaortic node sampling

No adjuvant treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you treat Stage IA grade 3 or IB Grade 1-2?

A

Vaginal brachytherapy alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for Stage IB Grade 3 to II

A

TAH/BSO

pelvic cytology

PLND + paraaortic sampling

  1. EBRT
  2. +Vaginal brachytherapy for Stage II
19
Q

Stage III treatment options

A

TAH/BSO

pelvic cytology

PLND + paraaortic sampling

  1. Chemotherapy alone
  2. RT alone: pelvis + PA +/- vaginal cuff RT
  3. Chemo+ RT + chemo (sandwich chemo)
  4. Concurrent chemoradiation
  5. EBRT + concurrent cisplatin then carbo/taxol x 4 cycles
20
Q

Treatment options for Stage IV disease

A

If Grade 1-2 and ER/PR+: Megace

21
Q

Treatment for Papillary serous or Clear cell

A
  1. Surgery:

TAH/BSO and PAN dissection,

omentectomy

pelvic cytology

  1. Chemo (cisplatin and doxorubicin)
  2. Pelvic RT + Vaginal brachytherapy
22
Q

What chemotherapy is usually used in sandwich chemo?

A

Carboplatin and taxol x 6 cycles

23
Q

Small bowel Dose contraints

A

Small bowel V40 < 30%

24
Q

CT simulation

A

Supine

IV contrast

Small bowel contrast

Indexed bag

Mark vaginal cuff

Scan with bladder full, then rescan with empty

Fuse scans together to create ITV

25
Q

IMRT Volumes

A

Superior: L4-5 at the bifurcation of the aorta

Include the external iliac, internal iliac and common iliacs Include the presacral nodes if the tumor involves the cervix

Use a 7 mm expansion around the vessels coming off bone, bowel and muscle

Connect Nodal volumes with sacral volume and its inferior border is S3 PTV = 7 mm + CTV

26
Q

Vaginal/Parametrial ITV volume

A

Superior border of CTV: When you see tissue between bladder and rectum Inferior border:

Include 3 cm of vaginal cuff- usually to mid pubis

Lateral: edge of nodal CTV of obturator

Anterior: Include 1 cm rim of bladder

Posterior border: curve around the rectum

27
Q

What doses to you use when you combine EBRT with brachytherapy?

A

45 Gy at 1.8 Gy/fx 5 Gy x 3 with vaginal cylinder HDR. Precribe to 5 mm from vaginal surface and separate by 1 week each.

28
Q

What RT dose do you use with HDR brachytherapy alone?

A

5.5 Gy x 4 fractions. Prescribe to 5 mm from vaginal surface. Separate by 1 week.

29
Q

What RT dose with pelvic RT alone?

A

50.4 Gy at 1.8 Gy/fx

30
Q

Dose constraints for vagina?

A

Upper vaginal mucosa: 150 Gy

Midvaginal mucosa: 80-90 Gy

Lower vaginal mucosa: 60-70 Gy

31
Q

Acute complications of RT?

A
  1. Frequent and urgent urination
  2. Diarrhea
32
Q

Late complications of RT?

A
  1. Vaginal stenosis
  2. Second cancers
  3. Rectal bleeding
  4. Hematuria
  5. SBO
33
Q

Bladder dose constraints?

A

V45<35%

34
Q

Rectum dose constraints

A

V30<60%

35
Q

Femoral head constraint?

A

V30<15%

36
Q

5 year OS for papillary serous and clear cell histologies?

A

5 year OS: 50%

37
Q

What study supports VB alone for patients with high intermediate risk disease?

A

PORTEC 2

1) Pelvic RT to 46 Gy
vs.
2) Vaginal brachytherapy 7 Gy x 3 or 30 Gy of LDR

5 year risk of pelvic recurrence was 0.5% vs. 3.8%, p=0.02

5 year vaginal recurrence rate was 1.6% vs. 1.8%

5 year OS was 79.6% vs. 84.8%, p=0.57

38
Q

What is the 5 year OS for patients with Stage III disease?

A

40-70%

39
Q

What is the 5 year OS for patients with Stage IV?

A

5 year OS is 0-10%

40
Q

What study supports the use of EBRT for patients with high intermediate risk disease?

A

ASTEC/NCIC: EBRT +/- VB vs. OBS: 3% improvement in locoregional control. No difference in OS.

GOG 99: EBRT vs. OBS (Low and Int): Lower recurrence improved in the high intermediate group only

Aalders: EBRT+/- VB vs. OBS (Low and Int): Lower recurrence only in IC grade 3

PORTEC 1: EBRT vs. OBS: Lower recurrence with EBRT

41
Q

Treat with bladder full or empty?

A

Full

42
Q

What is the typical length of vaginal cuff treated with a vaginal cylinder?

A

4 cm

43
Q

PTV margin

A

CTV + 7 mm

Endometrial Cancer (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions