Endometrial Cancer

Question 1

Occurs in women with history of chronic estrogen exposure unopposed by progestin

Estrogen dependent neoplasm

Answer 1

TYPE I ENDOMETRIAL CANCER (80%)

Question 2

Estrogen independent neoplasm

Have high grade nuclear atypia with serous or clear cell histology

Answer 2

TYPE II ENDOMETRIAL CANCER (20%)

Question 3

Important component in staging and prognosis of endometrial cancer

Answer 3

Depth of myometrial invasion

Question 4

The MOST IMPORTANT PROGNOSTIC FACTOR for endometrial carcinoma

Answer 4

Histologic grade

Question 5

Average age of diagnosis endometrial ca

Answer 5

61

Question 6

Risk Factors of Endometrial Cancer

unopposed estrogen stimulation of the endometrium

Answer 6

unopposed menopausal estrogen (4-8x)
menopause after 52 years (2.4x)
obesity (2-5x)
nulliparity (2-3x)
diabetes (2.8x)
insulin resistance
estrogen secreting ovarian tumors
PCOS
Tamoxifen therapy for breast cancer

1st degree relative of uterine cancer
known family history of Lynch II syndrome (HNPCC)
Germline mutations - Cowden syndrome, Peutz Jeghers Syndrome
Personal hx of breast cancer

Question 7

Protective Factors of Endometrial Cancer

Answer 7

decrease lifetime estrogen exposure - combination OCP and combination estrogen and progesterone hormone replacement therapy

high parity
pregnancy
physical activity
SMOKING - increased hepatic metabolism of estrogen

Question 8

Symptoms of endometrial cancer

Answer 8

ABNORMAL UTERINE BLEEDING - heavy or prolonged menstrual bleeding, intermenstrual bleeding, postcoital spotting or oligomenorrhea

Question 9

Diagnostic evaluation for endometrial cancer

Answer 9

Endometrial Biopsy

TSH
prolactin level
FSH
estradiol
CA 125
cbc
Pap smear
Pelvic ultrasound

Question 10

Less than 6% solid components

Answer 10

Grade 1 (Well Differentiated)

Question 11

6-50% solid components

Answer 11

Grade 2 (Moderately Differentiated)

Question 12

> 50% solid components

Answer 12

Grade 3 (Poorly Differentiated)

Question 13

Initial Management of Endometrial Cancer

Answer 13

Extrafascial hysterectomy (EH)
Bilateral Salpingo-oophorectomy (BSO)
Para-aortic lymphadenectomy (PALS)

Question 14

Stage I

confined to CORPUS

Answer 14

EH +BSO, PFC,BLND

Question 15

Stage II

Extension to CERVIX but NOT beyond the uterus

Answer 15

RH + BSO

PFC,BLND

Question 16

Stage III

OUTSIDE UTERUS within pelvis

Answer 16

EH + BSO, PFC, BLN eval

Question 17

Stage IV

INVADES bladder and/or bowel mucosa +/- distant metastasis

Answer 17

EH + BSO Debulking

Question 18

High Risk Features of Endometrial Cancer

Answer 18

> 50% myometrial invasion
serous or clear cell tumors
grade 3 tumors (> 50% solid growths)
large tumor (> 2 cm or filling cavity)
spread beyond the uterine fundus
lymphovascular involvement

Question 19

Degree of malignant transformation to endometrial carcinoma

Answer 19

simple hyperplasia w/o atypia - 1%

complex hyperplasia w/o atypia - 3%

complex hyperplasia w/ atypia - 29%

Question 20

Treatment of advanced or recurrent endometrial carcinoma

Answer 20

Tumor directed radiation therapy
Chemotherapy
High dose progestin therapy

Question 21

Overall 5 year survival rate

Answer 21

65%

85% to 100% recurrences occuring in the first 3 years after treatment

Question 22

Postmenopausal women taking tamoxifen are at increased risk for

Answer 22

endometrial proliferation
hyperplasia
EIN
polyp formation
invasive endometrial carcinoma
uterine sarcoma