Endometrial Flashcards
What mutations should be tested
mismatch repair mutations (MMR), p53, POLE (favorable)
Desribe the two main types
Type 1: endometrioid adenocarcinoma (70-80%) of patients. Estrogen-related
** Type 2:** serous, clear cell. Higher grade tumors. Not estrogen-related. More aggressive clinical course
What are negative prognostic indicators
- Age >60
- grade 3
- Over 50% myometrial invasion
- LVSI
- large tumor
- non endometroid histology
- Lower uterine segment invovlement
- poor PS
What % of patients with pelvic nodes have PALN
30-50%
Describe the staging for endometrial carcinoma
1A: < 50% myometrial invasion
1B: > 50%
II: Invades cervical stroma but not beyond the uterus
IIIA: uterine serosa/adnexa
IIIB: vagina/parametrium
IIIC1: pelvic node +
IIIC2: paraaortic node +
IVa: bowerl/bladder invasion
IVb: distant mets
What is the general tx paradigm
Surgery fist: Total abdominal hysterectomy + bilateral salpingo-oophorectomy
Does peritoneal cytology affect staging?
No, but should be reported
What does surgery involve
Most patients get a simple extrafascial hysterectomy and a BSO and if they have cervical stromal involvement then a modified radical hysterectomy will be performed
peritoneal cytology will be collected
Omendatl biopsy should be obtained and a omentectomy performed if papillary serous or clear cell histology
Pelvic LN evaluation: SLN biopsy, PLND (paraortic node evaluation if pelvic node +)
PET/CT or CT AP should be done before
What is the adjuvant therapy for stage 1A, G1-G2
Observation
VCB if >70 and/or
if LVSI ( Per GOG 99)
What is the adjuvant therapy for
Stage 1A, Stage IA, G3
Stage IB, G1-2G3
VCB ( Per Portec 1 and 2)
What is the adjuvant tx for Stage IB, G3
Pelvic EBRT +/- VCB
What is the adjuvant tx for Stage II
Pelvic EBRT +/- VCB or chemo+VCB
What is the adjuvant tx for Stage III-IVA
Sandwich chemotherapy -> EBRT + VCB–> chemotherapy
How to treat inoperable
Pelvic EBRT + intracavitary brachytherapy boost +/- chemo
When to add VCB
> 50% myometrial invasion
G3
serious/clear cell ( treated as G3)
cervical/vaginal invasion
LVSI
especially if the pt is over 70
When to add pelvic EBRT
if >50% and G3
Cervical stromal invasion
positive margin
locally invasive
When to add chemo
If locally invasive, LN+
What is the vaginal cuff brachy dose alone
21 Gy/3 fracctions prescribed to 5 mm depth, treat proximal 4 cm of vagina
What is the vaginal cuff brachy dose with EBRT
10 Gy/2 fx
Describe pelvic EBRT volumes for endometrial cancer
CTV 45 Gy: pelvis ( proximal half of vagina+paravaginal + parametria, lymph nodes)
If cervical stromal invasion- add presacral (superior border L4/L5)
If uterine fundus- include paraaortics
If distal vagina- then include all of vagina and inguinal nodes
Include 1 cm of posterior bladder and anterior rectum
7mm around the nodes
What nodes to include if cervical stromal invasion
then add presacral nodes, upper border L4/L5- S3
What nodes to include if fundus invasion
paraaortic nodes as it can directly drain there
What if distal vaginal involvement
Include all of the vagina and inguinal nodes
what is the nodal boost dose
CTV5625/25fx
