Endometrial Ca/PMB

Question 1

Incidence of PMB

Answer 1

7 in 1000

Question 2

Risk of endometrial cancer after PMB

Answer 2

10%

Question 3

Risk of malignancy in endometrial polyp pre-menopause

Answer 3

1-2%

Question 4

Risk of malignancy in endometrial polyp post-menopause

Answer 4

5-6%

Question 5

Relative risk of endometrial cancer after breast cancer

Answer 5

2-3x

Question 6

TV USS sensitivity for detecting endometrial ca

Answer 6

80%

Question 7

Stage 1

Answer 7

Confined to uterine corpus and ovary

Question 8

Stage 1A

Answer 8

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

Question 9

Stage 1B

Answer 9

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

Question 10

Stage 1C

Answer 10

Aggressive histological type confined to endometrium or polyp

Question 11

Stage 2

Answer 11

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

Question 12

Stage 2A

Answer 12

Invasion of cervical stroma of non-aggressive histological types

Question 13

Stage 2B

Answer 13

Substantial LVSI of non-aggressive histological subtypes

Question 14

Stage 2C

Answer 14

Aggressive histological types with any myometral involvement

Question 15

Stage 3

Answer 15

Local and/or regional spread of tumour

Question 16

Stage 3A

Answer 16

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

Question 17

Stage 3B

Answer 17

Metastasis or direct spread to vagina and/or parametrium

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

Question 18

Stage 3C

Answer 18

Metastasis to para-aortic or pelvic lymph nodes or both

Question 19

Stage 3C1

Answer 19

Metastasis to pelvic lymph nodes

3C1i - micrometastasis
3C1ii - macrometastasis

Question 20

Stage 3C2

Answer 20

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

3C2i - micrometastasis
3C2ii - macrometastasis

Question 21

Stage 4

Answer 21

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)

Question 22

Endometrial stromal sarcomas spread to adnexa at what rate?

Answer 22

20-30%

Question 23

Malignant mixed mullerian tumours are composed of what?

Answer 23

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

Question 24

Leiomyosarcomas originate from where?

Answer 24

Fibroids in 5-10% cases
Good prognosis

Question 25

Histological subtypes of endometrial carcinoma

Answer 25

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

Question 26

Cut off for vessel involvement to determine extent of LVSI

Answer 26

>/= 5

Question 27

Incidence

Answer 27

9000 per year

Question 28

Risk factors

Answer 28

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

Question 29

Lynch syndrome is ______

Answer 29

autosomal dominant DNA mismatch repair condition

Question 30

Genes involved in Lynch syndrome

Answer 30

MSH2 MLH1 MSH6 PMS2

Question 31

Lifetime risk of EC with Lynch syndrome

Answer 31

25-60%

Question 32

Red flag symptoms

Answer 32

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

Question 33

If on HRT then review when _______

Answer 33

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

Question 34

Pipelle biopsy EC detection rate

Answer 34

90-100%

Question 35

Incidence of lynch syndrome

Answer 35

3 per 1000

Question 36

Lynch syndrome is associated with the following conditions

Answer 36

IBD acromegaly

Question 37

5yr survival stage 1 ca

Answer 37

90%

Question 38

5yr survival stage 2

Answer 38

75%

Question 39

5yr survival stage 3

Answer 39

50%

Question 40

5yr survival stage 4

Answer 40

15%

Question 41

Surgical treatment for endometrial cancer

Answer 41

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

Question 42

Non-surgical treatment of endometrial cancer

Answer 42

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

Question 43

Management of FIGO stage II/IV disease

Answer 43

Consider Debulking surgery or limited surgery for palliation

Question 44

Adjuvant therapy for low risk EC

Answer 44

None

Question 45

Adjuvant therapy for intermediate risk disease

Answer 45

Vaginal vault brachytherapy Omit for patients under 60

Question 46

Adjuvant therapy for high risk disease (lymph node staging)

Answer 46

Vaginal vault brachytherapy alone if no LVSI External beam radiotherapy if LVSI or high grade stage II with deep myometrial involvement

Question 47

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

Answer 47

External beam radiotherapy Chemotherapy when LVSI is present Brachytherapy alone for stage II low grade endometrioid cancers without deep invasion

Question 48

Adjuvant therapy for high grade endometrial disease

Answer 48

External beam radiotherapy with adjuvant chemotherapy OR sequential chemotherapy and radiotherapy Chemotherapy alone with vaginal brachytherapy if systematic lymphadenectomy was performed

Question 49

Risk of endometrial cancer recurrence with radiotherapy alone

Answer 49

18%