Endometrial Cancer Flashcards
The histologic feature of endometrial hyperplasia that is associated with the greatest risk of progression to invasive cancer is?
Nuclear Atypia
What precent of Endometrial Cancer is Stage I at diagnosis?
70% of cases
Treatment for Endometrial Hyperplasia?
Regression of hyperplasia has been observed in 80-90% of individuals receiving Medroxyprogesterone acetate (10 mg daily for 12-14 days/month) or micronized progesterone vaginal cream (100 mg for 12-14 days/month) when treated for 3 months
Risk of co-existing low grade endometrial carcinoma with EIN?
30-50% of cases
most minimally invasive Grade 1
Treatment for EIN?
Total Hysterectomy (w/ or w/out BSO)- provides definitive assessment of a possible concurrent carcinoma and effectively treats pre-malignant lesions
SUPRACERVICAL HYST IS UNACCEPTABLE
Risk of concurrent endometrial carcinoma in women with EIN?
30-50%
(PPALND as a routine part of treatment for EIN would result in a large majority of patients being subjected unnecessarily to the risks associated with comprehensive surgical staging)
Protective Factors for Type 1 Em Ca?
Smoking
Breastfeeding
Increasing parity
Progestin contraceptives
What does grade indicate for Em Ca?
how much solid component does it have (would expect most of it to be glandular)
Grade 1 → < 5% solid component
Grade 2 → 6-50% solid component
Grade 3 → > 50% solid component
Treatment of Em Ca?
Everyone gets surgery!
Removal of uterus, cervix, adnexa, PPALND, washings
FIGO Em Ca Stage I
Confined to Uterus
IA: < 50% myometrial invasion
IB: > 50% myometrial
FIGO Em Ca Stage II
Invades cervical STROMA (not glands)
FIGO Em Ca Stage III
Local/regional spread
3A: Serosa or adnexa 3B: Vaginal or parametrial involvement 3C: PPALN 3C1 -pelvic 3C2 - paraaortic
FIGO Em Ca Stage IV
4A: Bladder/Bowel invasion
4B: Distant Mets
Which Em Ca patients should receive radiation after surgery?
Stage I w/
- Grade 2
- Grade 3
- Depth of invasion to outer third
- LVSI
Most common type of uterine sarcoma?
Uterine leiomyosarcoma
EIN diagnosed on in office biopsy…. what to do next?
Rule out concurrent Em Ca w/ hysteroscopy
Prevent progression to Em Ca
Refer to Gyn Onc for surgical management (preferred)
Surgery for EIN by Generalist:
- TLH w/ or w/out BSO, peritoneal washings
- NO SUPRACERVICAL
- NO MORECELLATION
- Counsel patient on need for additional surgery if endometrial cancer diagnosed
Surgical treatment for EIN?
Preferably TLH by Onc
If done by generalist:
- Get washings
- Take cervix
- Don’t morcellate
- Counsel on possible additional procedures
Medical treatment for benign hyperplasia?
Medroxyprogesterone 20 mg daily
Micronized progesterone 200 mg daily
LNG 52 mg IUD
Combo OCPs
**Continue to sample Q3-6 months until normal
**If risk factors remain can continue indefinitely
Medical management of EIN(AEH)?
Optimal dose, treatment duration, and length of follow-up has not been determined!!
MUST do hysteroscopic sampling to r/o Em Ca
Megace 40-200 mg/d
LNG 52 mg IUD (highest rate of regression)
Medroxyprogesterone 20 mg daily
DMPA 150 mg q 3 months
Micronized progesterone 200 mg/daily
Highest rate of regression with medical management of EIN(AEH)?
LNG 52 mg IUD
When would GYN onc consider medical therapy for Em Ca?
Desire to preserve fertility or poor surgical candidate
pre menopausal
Stage I well differentiated (no myometrial invasion), Grade 1 endometrioid adenocarcinoma
IUD, Megace, Provera for 6 months
When done child bearing- then hyst!
Post treatment follow up for Em Ca?
H&P + recto/vaginal exam
Every 3 months for 2 years
Every 6 months for 3 years
Annually
Pelvic exam to identify local recurrence
