Brainscape's Knowledge GenomeTM

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


See full index

Gynae/Onc > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

1
Q

List the causes of PMB

A 
vaginal atrophy (60%)
hormonal effect
endometrial polyp
endometrial hyperplasia
endometrial cancer
cervical cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For a woman presenting with PMB what is her risk of cancer?

A

3-20%

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

For a woman presenting with PMB what is her risk for endometrial hyperplasia?

A

5-15%

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

What would you tell a woman presenting with PMB regarding management?

A 
Most likely benign cause
3-20% risk of cancer
5-15% risk of endometrial hyperplasia
Modifiable risk factors should be modified
Advise about the steps in investigation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In pre- menopausal bleeding what is the normal ET on TV USS?

A

<7mm is normal

TV USS useful to review structural anomalies

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

what is the ET cut off for TV USS in investigation of PMB?

A

3-4mm

Risk of cancer is <1% if the ET is less than cut off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the role of TVUSS in women on tamoxifen?

A

Women on Tamoxifen should only have TVUSS for investigation if they are symptomatic i.e. with PMB/PCB
Tamoxifen can cause thickened/cystic stripes
No cut off for TV USS - all symptoms should be investigated

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

What are the three principles for the management of hyperplasia?

A

Is there presence of atypia?
What are the women’ fertility wishes
What is the women’ suitability for surgery

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

For endometrial hyperplasia without atypia, what are the conservative management options used?

A 
Weight loss
Metformin
LNG-IUD/Mirena
Oral contraceptives
cyclical progesterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you justify conservative management of Endometrial hyperplasia without atypia?

A

Risk of progression to cancer is <5% in 20 years
Most regress spontaneously
Can just watch and wait
However much quicker regression if use progesterone treatment

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

What is the lifetime risk of uterine cancer?

A

1:45

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

What is the mainstay of management for uterine cancer?

A

Surgical resection

Radiation treatment reduces local recurrence but does not impact on survival

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

What are the risk factors of endometrial cancer?

A 
Endometrial hyperplasia
Obesity
T2DM
Hypertension
Nulliparity
Early menopause
PCOS
Tamoxifen treatment
Familial syndromes (Lynch, Cowden)
estrogen secreting tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What management steps would you take for a patient with endometrial cancer (lets say pipelle or D&C comes back with finding of invasive cancer)

A

Ca125 - high preoperative Ca125 associated with advanced disease
CT CAP (in Auckland we do MRI pelvis + CXR unless high grade known)
MDT
Confirmation of pathology

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

What are the intra-operative principles of staging an endometrial cancer?

A

Hysterectomy BSO (risk reduction ovarian ca)
+/- peritoneal washings (optional)
+/- pelvic +/- para-aortic lymph nodes
Minimally invasive surgery is an option

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

What are the management options for a confirmed endometrial cancer?

A 
Surgical (first line)
Conservative
- for the surgically unfit
- for women desiring fertility retention
Medical
- up front Chemo/Rad therapy in some scenarios
Palliative
17
Q

With regards to endometrial cancer, what is the current thoughts on lymphadenectomy?

A

Previously pelvic and para-aortic lymphadenectomy completed as standard
Now controversial - no survival benefit
apparent early endometrial cancer only associated with 19% LN positive
morbidity from lymphadenectomy ++

18
Q

what are the complications associated with lymphadenectomy?

A 
Intra-operative
- vessel injury
- nerve damage
- VTE
Post operative
- Lymphocele (20%)
- lymphoedema (1.5-28%) 60% report affect on ADLs
- infection
19
Q

During pelvic lymphadenectomy for endometrial cancer which nerves can be damaged?

A

Obturator

genitofemoral

20
Q

What are the non surgical management options for endometrial cancer?

A

Rationale - only if cannot perform surgery or fertility preserving
Progestin therapy - LNG-IUD + oral progestin
repeat endometrial biopsies (3-6 monthly)
optimise medical problems (pre-operatively)
consider bariatric surgery

21
Q

List 8 poor prognostic factors associated with endometrial cancer

A 
Increasing age (>65)
Stage (>1B)
Increasing myoinvasion
vascular invasion
Tumour extension beyond fundus
Grade 3
Histological subtypes (clear cell, serous, adenosquamous)
tumour >2cm
22
Q

Briefly describe LYNCH syndrome

A

most common form of hereditary colon cancer (1:1000 individuals)
Defect in DNA MMR genes (mismatch repair genes)
increased endometrial, ovarian, stomach, small intestine, hepatobiliary, ureter, brain and skin
50% present with Gynae cancer as their sentinel cancer
22% >stage 2

23
Q

Briefly describe the Cowden syndrome

A

autosomal dominant mutation of PTEN
PTEN - tumour supressor gene
loss of function of PTEN contributes to oncogenesis

24
Q

What are the key points for radiation treatment in endometrial cancer?

A
  • Vaginal brachytherapy can be used to reduce the risk of local recurrence following surgical resection
  • radiation therapy can be used for non surgically resectable disease
  • used in palliative treatment to control symptom of bleeding
  • used to treat recurrence
25
Q

in what scenario would you consider radiation therapy for stage 1 endometrial cancer?

A

If >2 poor prognostic factors could consider vaginal brachytherapy

  • if age >65
  • deep myometrial invasion
  • grade 3 disease
  • serous or clear cell histology
  • LVSI (lymph vascular space invasion)
26
Q

what did the SEER study show with regard to stage 2 endometrial cancer and radiation therapy?

A

For patient with clinically overt and surgically resectable stage 2 disease the SEER study showed that when adjuvant radiotherapy was used for these patients there was an improved survival (post both simple and radical hysterectomy)

27
Q

For stage 2 endometrial cancer when is radiation therapy considered appropriate?

A
  • Could argue that following SEER study then all surgical resectable overt stage 2 disease would benefit
  • if surgery is not considered feasible then full pelvic radiation therapy with intracavity brachytherapy may be employed
28
Q

What are the short term side effects of Radiation therapy? ‘itis’

A

urinary - radiation cystitis
GI - enteritis, colitis, proctitis
Vaginal - ulceration, erythema, discharge, infection
Skin - erythema, moist desquamation

29
Q

What follow up should women with endometrial cancer have?

A

NCCN guidelines:
physical exam every 3-6 months for 2-3 years, then 6-12 months
imaging as clinically indicated
patient education regarding symptoms or recurrence and sexual health
Ca 125 optional
Treatment of recurrence - MDT

30
Q

How does recurrence of endometrial cancer present?

A

5-15% of patients with early stage disease with have a recurrence
75% of recurrence will occur in the vagina and present with bleeding

31
Q

What are the long term side effects on the urinary tract of radiation therapy?

A

Urinary:

  • bladder fibrosis
  • haematuria
  • ulceration
  • pain
  • UV and VV fistula
32
Q

What are the long term side effects of radiation therapy on the Gut?

A

GI:

  • chronic enteropathy (chronic diarrhoea and malabsorption)
  • fibrosis - dysmotility or obstructive/ileus
  • ulcerations
33
Q

what are the vaginal side effects of radiation treatment long term?

A
  • sexual dysfunction
  • stenosis
  • vaginismus
  • adhesions
34
Q

what are the long term side effects of radiation treatment?

A
  • urinary - fibrosis, ulceration, reduced capacity, haematuria, pain
  • GI - chronic enteropathy - malabsorption, diarrhoea
  • vagina - stenosis, sexual dysfunction, ulceration
  • ovaries - premature menopause
  • bone - insufficiency fractures
  • skin - hyperpigmentation, talangiectasia, fibrosis
35
Q

What is the risk of malignancy in hyperplasia with atypia?

A

43% of cases showed invasive disease when hysterectomy performed
progression with atypia is quoted as 8% in 4yrs, 12% in 9 yrs nearly 30% after 19 yrs

36
Q

What is the risk of malignancy in hyperplasia with atypia?

A

43% of cases showed invasive disease when hysterectomy performed
progression with atypia is quoted as 8% in 4yrs, 12% in 9 yrs nearly 30% after 19 yrs

Gynae/Onc (14 decks)

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