Endometrial Cancer

Question 1

What are the 2 etiologies of endometrial cancer and which is more common?

Answer 1

Estrogen-Dependent (80%)- Type I

Estrogen-Independent (20%) - Type II

Question 2

Which type of endometrial cancer has a more favorable outcome?

Answer 2

Estrogen-dependent

Question 3

What are the characteristics of estrogen-independent endometrial cancer?

Answer 3

Serous or clear cell histology

Often associated with p53 mutation

Question 4

How does estrogen-dependent endometrial cancer arise?

Answer 4

Chronic unopposed estrogen exposure

Question 5

What is a major component in staging and prognosis of endometrial cancer?

Answer 5

Depth of myometrial invasion

Prognosis is dramatically worsened when over 1/2 thickness of myometrium invaded

Question 6

What is the most common route of endometrial cancer spread?

Answer 6

Direct extension of tumor downwards or outwards

Question 7

What is the most common type of endometrial cancer? What are other less common types?

Answer 7

Endometrial adenocarcinoma - proliferation of glandular cells

Mucinous, clear cell, papillary serous, squamous

Question 8

What is the most important prognostic factor for endometrial cancer?

Answer 8

Histologic grade

Question 9

What are risk factors for type I endometrial cancer?

Answer 9

Excess exogenous estrogen - unopposed ERT, tamoxifen for breast cancer
Excess endogenous estrogen - PCOS, obesity, nulliparous, early menarche/late menopause, DM, chronic anovulation
Family history of uterine cancer, Lynch syndrome

Question 10

What are protective factors for endometrial cancer?

Answer 10

Decreased estrogen exposure
OCPs
Multiparous
Physical activity

Question 11

What are the clinical symptoms of endometrial cancer?

Answer 11

Postmenopausal bleeding
Pelvic pain
pelvic mass
Weight loss

Question 12

What is the most common cause of postmenopausal bleeding?

Answer 12

Endometrial atrophy

Question 13

How is endometrial cancer diagnosed?

Answer 13

TVUS with EE>4mm
EMB*
D&C if EMB cannot be obtained

Question 14

What other labs should be drawn for evaluation of endometrial cancer?

Answer 14

TSH
Prolactin
FSH, estradiol
CBC
CA-125

Question 15

What are the treatment options for endometrial cancer?

Answer 15

Stage I - TAH/BSO, pelvic washings, lymphnode dissection
Radiation therapy if cancer has spread to serosa, or if it is large, or grade III (>50% solid component), serous or clear cell histology
Advanced/recurrent = Chemotherapy

Question 16

What is the overall 5-year survival for endometrial cancer?

Answer 16

65%

Question 17

When is endometrial cancer most likely to recur?

Answer 17

85-100% of recurrences occur within 3 years