Endometrial cancer

Question 1

What are facts about endometrial cancer?

Answer 1

70% stage 1 at ddx. If endometrial intra-epithelial neoplasia, 40% positive for invasive cancer at time of hyst!

Question 2

What are types of endometrial cancer?

Answer 2

Type 1=most common. RF=older age, white, unopposed estrogen, early menarche, tamoxifen use, obesity, Lynch syndrome (AD mutation in MLH1, MSH2, PMS2, MSH6), Cowden disease (AD, incr risk breast/thyroid/endometrial)

Type 2=clear cell (rare), papillary serous (10% of all cases but 40% deaths). High grade, carcinosarcoma (malignant mixed mullerian tumor)

Question 3

What is Endometrial intraepithelial neoplasia?

Answer 3

Hysteroscopy D&C is best, total hyst=definitive tx. CANNOT do supracervical hyst or endometrial abiation
If desire fertility or poor surgical candidate, use systemic/local progestin
Progestins (medroxyprogesterone acetate, megestrol acetate): induce secretory differentiation, activate progesterone receptors causing stromal decidualization
Background: unopposed estrogen causes proliferative glandular epithelial changes
If on TVUS in postmenopausal,, 4mm thickness but ASYMPTOMATIC -> no followup
Risk of high-risk uterine cancer in EIN is 10%
tx=hyst with/without BSO, peritoneal washings

Question 4

What is management of papillary serous cancer?

Answer 4

TAH/BSO, pelvic washings, pelvic/para-aortic LN dissection
- then chemo

Question 5

What is simple hyperplasia without atypia?

Answer 5

1% progresses to neoplasia
-penny

Question 6

What’s simple hyperplasia WITH atypia?

Answer 6

10% progresses to neoplasia

Question 7

What is complex hyperplasia without atypia?

Answer 7

5% progresses to neoplasia

Question 8

What is complex hyperplasia WITH atypia

Answer 8

25-40% progresses to neoplasia
- AKA endometrial intraepithelial neoplasia (EIN)