Endometrial Cancer Flashcards
How would you sim the patient
Supine
Arms on chest
Empty rectum
Full bladder
* Vaginal marker to help find the vaginal cuff*
PORTEC- I
Q: Addition of WPRT to surgery for patients with early stage endometrial carcinoma
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High risk features
1) age>60
2) >50% of myometrium
3) Grade 3
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for these ppl 10 year LRR was reduced from 23% to 5 % by receiving WPRT
PORTEC II
Pelvic recurrence was more common in VBT arm
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Inclusion criteria:
- Age>60 yrs, G1-2 disease, >50% of myometrium
- Age>60 yrs, G3 disease, <50% of myometrium
- Stage II A
- Any age >50% myometrium but not G3
PORTEC III
Peters criteria
Positive LN
Positive margins
Parametria involvement
Saddlers Criteria
RTOG 90-01 LN borders
L1-L2 for para aortic nodes
Staging
GOG 33
LN involvement increase with increase grade and DOI
Grade 2, deep 1/3 more risky thank grade 3 in middle 1/3 of myometrium.
Medically inoperable endometrial adenocarcinoma brachy applicator
Tandem and ovoids
Prognostic molecular groups as per
PORTEC
PRoMisE
1) POLE mutation= BEST prognosis
2) MSI (microsatellite instability)= Intermediate prognosis
3) Copy number HIGH + TP53 mutation = WORST prognosis (aggressive growth, early mets)
4) Copy number low = intermediate prognosis
Point A
2cm superior to ovoids and 2cm lateral to tandem
Point B
3cm lateral to point A or 5 cms lateral to midline
How much of vagina should be treated with brachy
3-5cms of proximal
GOG 99
High risk features:
1) LVSI
2) Outter 1/3 of myometrium
3)G2/G3
Age >70 yrs with 1 HR
Age >50 with 2 HR
any age with all 3 HR
Types of hysterectomy
