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MRCOG part 2 > Endometrial Ca/PMB > Flashcards

Endometrial Ca/PMB Flashcards

1
Q

Incidence of PMB

A

7 in 1000

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2
Q

Risk of endometrial cancer after PMB

A

10%

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3
Q

Risk of malignancy in endometrial polyp pre-menopause

A

1-2%

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4
Q

Risk of malignancy in endometrial polyp post-menopause

A

5-6%

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5
Q

Relative risk of endometrial cancer after breast cancer

A

2-3x

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6
Q

TV USS sensitivity for detecting endometrial ca

A

80%

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7
Q

Stage 1

A

Confined to uterine corpus and ovary

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8
Q

Stage 1A

A

Disease limited to endometrium OR non-aggressive type OR good prognosis disease
1A1 - non aggressive type limited to endometrial polyp/endometrium
1A2 none aggressive type involving <50% myometrium with no or focal LVSI
1A3 - low grade endometrioid carcinoma limited to uterus or ovary

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9
Q

Stage 1B

A

Non-aggressive histological type with invasion >50% of myometrium with no or focal LVSI

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10
Q

Stage 1C

A

Aggressive histological type confined to endometrium or polyp

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11
Q

Stage 2

A

Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological subtype involving myometrium

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12
Q

Stage 2A

A

Invasion of cervical stroma of non-aggressive histological types

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13
Q

Stage 2B

A

Substantial LVSI of non-aggressive histological subtypes

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14
Q

Stage 2C

A

Aggressive histological types with any myometral involvement

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15
Q

Stage 3

A

Local and/or regional spread of tumour

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16
Q

Stage 3A

A

Invasion of uterine serosa and/or adnexa by direct extension or metastasis

3A1 - spread to ovary or fallopian tube
3A2 - involvement of uterine subserosa or spread through serosa

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17
Q

Stage 3B

A

Metastasis or direct spread to vagina and/or parametrium

3B1 - metastasis or direct spread to vagina/parametrium
3B2 - metastasis to pelvic peritoneum

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18
Q

Stage 3C

A

Metastasis to para-aortic or pelvic lymph nodes or both

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19
Q

Stage 3C1

A

Metastasis to pelvic lymph nodes

3C1i - micrometastasis
3C1ii - macrometastasis

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20
Q

Stage 3C2

A

Metastasis to para-aortic lymph nodes up to the renal vessels

3C2i - micrometastasis
3C2ii - macrometastasis

21
Q

Stage 4

A

Spread to bladder mucosa/intestinal mucosa/distant sites

4A - invasion of bladder/intestine
4B - peritoneal metastasis beyond the pelvis
4C - distant mets (including intra-abdominal lymph nodes above renal vessels)

22
Q

Endometrial stromal sarcomas spread to adnexa at what rate?

A

20-30%

23
Q

Malignant mixed mullerian tumours are composed of what?

A

Stromal and glandular elements
Can be homologous (cell type found in uterus)
Or heterologous (extra-uterine cell type eg osteosarcoma)

24
Q

Leiomyosarcomas originate from where?

A

Fibroids in 5-10% cases
Good prognosis

25
Q

Histological subtypes of endometrial carcinoma

A

Endometrioid (EEC)
Serous sarcoma
Clear cell carcinoma
Mixed carcinoma
Undifferentiated carcinoma
Carcinosarcoma
Other unusual types
Gastrointestinal mucinous type carcinomas

26
Q

Cut off for vessel involvement to determine extent of LVSI

A

> /= 5

27
Q

Incidence

A

9000 per year

28
Q

Risk factors

A

Obesity (5kg/m2 = 50% increase in risk)
Age (85% >55yo)
PCOS
lynch syndrome
Diabetes
HTN
Early menarche/late menopause
Nulliparity
Unopposed oestrogen therapy
Cowden syndrome
Family history
Tamoxifen
Diet
Physical inactivity

29
Q

Lynch syndrome is ______

A

autosomal dominant DNA mismatch repair condition

30
Q

Genes involved in Lynch syndrome

A

MSH2
MLH1
MSH6
PMS2

31
Q

Lifetime risk of EC with Lynch syndrome

A

25-60%

32
Q

Red flag symptoms

A

PMB
pyometra
Vaginal discharge
IMB
Persistent HMB
Abdominal distension
Pelvis pressure or pain

33
Q

If on HRT then review when _______

A

Persistent unscheduled bleeding for 6 months OR
New onset PMB persisting 6 weeks after stopping

34
Q

Pipelle biopsy EC detection rate

A

90-100%

35
Q

Incidence of lynch syndrome

A

3 per 1000

36
Q

Lynch syndrome is associated with the following conditions

A

IBD
acromegaly

37
Q

5yr survival stage 1 ca

A

90%

38
Q

5yr survival stage 2

A

75%

39
Q

5yr survival stage 3

A

50%

40
Q

5yr survival stage 4

A

15%

41
Q

Surgical treatment for endometrial cancer

A

TAH + BSO
Could have ovarian sparing surgery if pre-menopausal and low grade/risk disease
Sentinel lymph node biopsy and omental biopsy if higher grade disease

42
Q

Non-surgical treatment of endometrial cancer

A

If unfit - vaginal hysterectomy, pelvic radiotherapy or progestin/aromatase inhibitors

Intra-cavity brachytherapy for low grade, stage 1 tumours without deep myometrial invasion

Combined external beam radiotherapy for stage II or high grade or deep myometrial invasion

43
Q

Management of FIGO stage II/IV disease

A

Consider Debulking surgery or limited surgery for palliation

44
Q

Adjuvant therapy for low risk EC

A

None

45
Q

Adjuvant therapy for intermediate risk disease

A

Vaginal vault brachytherapy
Omit for patients under 60

46
Q

Adjuvant therapy for high risk disease (lymph node staging)

A

Vaginal vault brachytherapy alone if no LVSI

External beam radiotherapy if LVSI or high grade stage II with deep myometrial involvement

47
Q

Adjuvant therapy for high intermediate risk disease (no lymph nodes)

A

External beam radiotherapy

Chemotherapy when LVSI is present

Brachytherapy alone for stage II low grade endometrioid cancers without deep invasion

48
Q

Adjuvant therapy for high grade endometrial disease

A

External beam radiotherapy with adjuvant chemotherapy OR sequential chemotherapy and radiotherapy

Chemotherapy alone with vaginal brachytherapy if systematic lymphadenectomy was performed

49
Q

Risk of endometrial cancer recurrence with radiotherapy alone

A

18%

MRCOG part 2 (22 decks)

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