Endometrial cancer

Question 1

Stage I

Answer 1

Confined to the uterine corpus and ovary

Question 2

IA

Answer 2

Disease limited to the endometrium OR non-aggressive histological type, i.e. low-grade endometroid, with invasion of less than half of myometrium with no or focal lymphovascular space involvement (LVSI) OR good prognosis disease

Question 3

IA1

Answer 3

Non-aggressive histological type limited to an endometrial polyp OR confined to the endometrium

Question 4

IA2

Answer 4

Non-aggressive histological types involving less than half of the myometrium with no or focal LVSI

Question 5

IA3

Answer 5

Low-grade endometrioid carcinomas limited to the uterus and ovary

Question 6

IB

Answer 6

Non-aggressive histological types with invasion of half or more of the myometrium, and with no or focal LVSI

Question 7

IC

Answer 7

Aggressive histological typese limited to a polyp or confined to the endometrium

Question 8

Stage II

Answer 8

Invasion of cervical stroma without extrauterine extension OR with substantial LVSI OR aggressive histological types with myometrial invasion

Question 9

IIA

Answer 9

Invasion of the cervical stroma of non-aggressive histological types

Question 10

IIB

Answer 10

Substantial LVSId of non-aggressive histological types

Question 11

IIC

Answer 11

Aggressive histological typese with any myometrial involvement

Question 12

Stage III

Answer 12

Local and/or regional spread of the tumor of any histological subtype

Question 13

IIIA

Answer 13

Invasion of uterine serosa, adnexa, or both by direct extension or metastasis
IIIA1 Spread to ovary or fallopian tube (except when meeting stage IA3 criteria)c

IIIA2 Involvement of uterine subserosa or spread through the uterine serosa

Question 14

IIIB

Answer 14

Metastasis or direct spread to the vagina and/or to the parametria or pelvic peritoneum
IIIB1 Metastasis or direct spread to the vagina and/or the parametria

IIIB2 Metastasis to the pelvic peritoneum

Question 15

IIIC

Answer 15

Metastasis to the pelvic or para-aortic lymph nodes or bothf
IIIC1 Metastasis to the pelvic lymph nodes

IIIC1i Micrometastasis

IIIC1ii Macrometastasis

IIIC2 Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes

IIIC2i Micrometastasis

IIIC2ii Macrometastasis

Question 16

Stage IV

Answer 16

Spread to the bladder mucosa and/or intestinal mucosa and/or distance metastasis

Question 17

IVA

Answer 17

Invasion of the bladder mucosa and/or the intestinal/bowel mucosa

Question 18

IVB

Answer 18

Abdominal peritoneal metastasis beyond the pelvis

Question 19

IVC

Answer 19

Distant metastasis, including metastasis to any extra- or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain, or bone

Question 20

Treatment STAGE 1a GRADE-1

Answer 20

Lap TAH+BSO, no adjuvant RT

Question 21

VAGINAL BRACHYTHERAPY EBRT: for nodes positive with

Answer 21

For patients with high/intermediate risk factors (at least two of the factors:
a. age >60 years,
b. deep myometrial invasion,
c. grade 3,
d. serous or clear cell histology,
e. LVSI,

Question 22

STAGE 3 AND 4:

Answer 22

staging laparotomy and aim to debulk disease, with systemic lymphadenectomy.
* If both the para-aortic and pelvic nodes are negative use adjuvant vault radiotherapy + EBRT, which reduces
local recurrences
* Patients with clinical Stage III endometrial carcinoma in which surgical resection is not possible are treated
primarily by pelvic irradiation, with or without chemotherapy. Once therapy has been completed, exploratory
laparotomy should be considered for those patients whose disease now appears to be resectable

Question 23

STAGE 4

Answer 23

Treatment should be individualized to achieve local control. Pulmonary metastases are the most
common site of distant disease.
* A combination of surgery, radiotherapy for palliative local control, and chemotherapy for distant
control can be used.
* NCT :- poor candidates for surgery. Carboplatin+ paclitaxel
* Progestogens have been demonstrated to be useful for pulmonary metastases. (Response rates vary
from 0 to 53%).
* Pelvic radiotherapy in Stage IV disease is sometimes considered to provide local tumor control.
Similarly, it has also been suggested that patients with vaginal bleeding or pain from a local tumor
mass, or with leg edema due to lymph node involvement, should be treated with pelvic radiotherapy.
Palliation of brain or bone metastases can be effectively obtained with short courses (1–5fractions) of
radiotherapy

Question 24

RECURRENT DISEASE

Answer 24

7-18%

Question 25

Risk with obesity

Answer 25

3-10 fold

Question 26

diabetes risk

Answer 26

40-80%

Question 27

unapposed estrogen risk

Answer 27

6-8 fold risk

Question 28

tamoxifen risk

Answer 28

3-6 fold

Question 29

Continuous combined HRT effect

Answer 29

reduces risk by 76%

Question 30

Sequential HRT effect

Answer 30

70% increased risk

Question 31

estrogen-only HRT risk

Answer 31

50% increase PMB (risk of cancer is 10

Question 32

Endometrial sample(Pipelle)

Answer 32

False negative 10-15%

Question 33

Lynch type 2
syndrome with a wish for fertility preservation,

Answer 33

endometrial surveillance is performed by aspiration biopsy
and transvaginal ultrasonography starting from the age of 35 years (annually until hysterectomy).
Prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy), preferably using a
minimally invasive approach, should be discussed at the age of 40

Question 34

Risk of endometrial hyperplasia without atypia progressing to endometrial
cancer is

Answer 34

less than 5% over 20 years.

Question 35

Risk of progression to carcinoma-
* Hyperplasia without atypia

Answer 35

2%

Question 36

Risk of progression to carcinoma- Simple atypical hyperplasia

Answer 36

23%

Question 37

Risk of progression to carcinoma-Complex atypical hyperplasia

Answer 37

29%

Question 38

Adenocarcinoma co exists in what % atypical complex hyperplasia

Answer 38

25%

Question 39

Type 2 genetic factor

Answer 39

p53 mutation

Question 40

Type 1 genetic factor

Answer 40

PTEN , K-RAS