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MOHD Keystone exam 3 > Endometrial Cancer > Flashcards

Endometrial Cancer Flashcards

1
Q

endometrial cancer is staged ______

A

surgically (Cervical=Clinically)

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2
Q

Pattern of spread for endometrial cancer:

A

direct extension (most common) and lymphatics; (can also be transtubal or hematogenous - lung is most common, also to liver, brain, bone)

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3
Q

____ and ____ determine treatment of endometrial cancer

A

surgical staging and health of patient

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4
Q

RF for endometrial cancer include:

A
  • obesity

- unopposed stimulation of estrogen receptors

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5
Q

Classic symptom of endometrial cancer

A

postmenopausal bleeding

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6
Q

diagnosis of endometrial cancer is made by:

A

endometrial sampling

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7
Q

most common type of endometrial cancer

A

Type 1 endometrial cancer (estrogen dependent)

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8
Q

non-estrogen dependent endometrial cancer

A

Type II

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9
Q

endometrial cancer with better prognosis

A

Type I (estrogen dependent)

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10
Q

endometrial cancer more related to obesity

A

Type I (estrogen dependent)

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11
Q

Most common site of recurrence (2)

A

vaginal or pelvic

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12
Q

site of recurrence with best prognosis is:

A

isolated vaginal

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13
Q

____ % recurrences occur within 2 years of treatment

A

50% (cervical is 80%)

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14
Q

most common site of hematogenous spread

A

lung; (liver, brain, bone also common)

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15
Q

peak age with highest prevalence

A

60-70 y.o.

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16
Q

prevalence of endometrial cancer if

A

2-5%

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17
Q

Risk factors for endometrial cancer:

A

unopposed estrogen therapy, late menopause, PCOS, obesity, DM, HNPCC

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18
Q

protective factors for endometrial cancer:

A

combined OCPs (progestin); physical activity; pregnancy/breastfeeding; diet low in SF; smoking

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19
Q

Type II endometrial cancer histo types:

A
  • papillary squamous
  • clear cell
  • adenosquamous
  • undifferentiated
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20
Q

p53 mutations are most common in type __ endometrial cancer

A

type 2

21
Q

PTEN mutations, MSI are most common in type __ endometrial cancer

A

type 1

22
Q

mets found in peritoneum suggest type ___ endometrial cancer

A

type 2

23
Q

mets found in the LNs and ovarian involvement suggest type __ endometrial cancer

A

type 1

24
Q

type of endometrial cancer with a favorable prognosis

A

type 1

25
Q

atypical endometrial hyperplasia is the precursor lesion for type ___ endometrial cancer

A

type 1; type 2 has less defined precursor lesion

26
Q

type of endometrial cancer often with later onset (70s)

A

type 2; (type 1 presents in 50-60s)

27
Q

leiomyosarcoma

A

rapidly growing fibroid, should be evaluated

28
Q

MMMT

A

malignant mixed Mulerian tumor (carcinosarcoma)

29
Q

3 other types of uterine cancer:

A
  • leiomyosarcoma
  • stromal sarcoma
  • carcinosarcoma (MMMT)
30
Q

symptoms of uterine cancer

A
  • PMB
  • PM endometrial cells on cervical cytology
  • perimenopausal abnormal uterine bleeding (heavy or irregular)
  • premenopausal w abnormal uterine bleeding w history of anovulation
31
Q

PMB differential diagnosis includes:

A
  • atrophic endometritis/vaginitis (low estrogen state)
  • endometrial/cervical polyps
  • exogenous use of estrogen or drugs which stimulate estrogen receptors (tamoxifen)
  • endometrial hyperplasia; endometrial cancer; other gyn cancers
32
Q

precursor to endometrial cancer is _____ and presents as ____

A

endometrial hyperplasia and endometrial intraepithelial neoplasia (EIN); abnormal bleeding

33
Q

benign irregular dilated glands (with or w/o atypia) indicate:

A

Simple endometrial hyperplasia or EIN

34
Q

proliferation of glands with irregular outlines, back to back crowding of glands (w/ or w/o atypia)

A

Complex endometrial hyperplasia or EIN

35
Q

43% of ______ endometrial hyperplasia harbor coexisting carcinoma

A

complex atypical hyperplasia

36
Q

work-up of endometrial cancer involves:

A

endometrial biopsy (need tissue=90% sensitive) +/- TVUS; if negative, observe; D&C for more sensitive; + = pre-opp assessment

37
Q

endometrial preoperative workup involves

A

labs, CT of abdomen/pelvis (if advanced disease suspected), CXR, EKG

38
Q

stage of endometrial cancer in uterine corpus

A

Stage I (Ia 1/2 myometrium)

39
Q

stage of endometrial cancer in uterine corpus and cervical stroma

A

stage II (does not go beyond uterus)

40
Q

endometrial cancer in serosa/adnexa, vagina and para-aortic lymph nodes is stage:

A

stage III

41
Q

endometrial cancer found in bladder/bowel mucosa and with distant mets is stage:

A

stage iv

42
Q

5 year survival for endometrial cancer found in vagina and para-aortic LNs is:

A

52-60% (stage III)

43
Q

5 year survival of stage IV endometrial cancer is:

A

14-17%; 3 % are diagnosed at this stage

44
Q

5 year survival of this stage is 81-91%:

A

stage I (72% are diagnosed at this stage)

45
Q

5 year survival of endometrial cancer found in cervix

A

71-78% (stage II)

46
Q

most important prognostic factor in clinically early endometrial cancer is:
-LN mets; histo type (papillary serous/ clear cell or HG endometroid); deep mometrial invasion; tumor size; lymphovascular space invasion or only adnexal invovement?

A 
LN metastasis (40% decrease in 5 year survival and 6 fold higher recurrence rate);
-all others are also prognostic factors
47
Q

primary treatment of endometrial cancer is surgery or radiation?

A

surgery: hysterectomy/BSO/+-pelvic/paraaortic LND (PPLND)

48
Q

primary radiation is indicated in endometrial cancer patients that:

A

cannot tolerate surgery (3-5% of patients)

MOHD Keystone exam 3 (9 decks)

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