Endometrial Cancer Flashcards
endometrial cancer is staged ______
surgically (Cervical=Clinically)
Pattern of spread for endometrial cancer:
direct extension (most common) and lymphatics; (can also be transtubal or hematogenous - lung is most common, also to liver, brain, bone)
____ and ____ determine treatment of endometrial cancer
surgical staging and health of patient
RF for endometrial cancer include:
- obesity
- unopposed stimulation of estrogen receptors
Classic symptom of endometrial cancer
postmenopausal bleeding
diagnosis of endometrial cancer is made by:
endometrial sampling
most common type of endometrial cancer
Type 1 endometrial cancer (estrogen dependent)
non-estrogen dependent endometrial cancer
Type II
endometrial cancer with better prognosis
Type I (estrogen dependent)
endometrial cancer more related to obesity
Type I (estrogen dependent)
Most common site of recurrence (2)
vaginal or pelvic
site of recurrence with best prognosis is:
isolated vaginal
____ % recurrences occur within 2 years of treatment
50% (cervical is 80%)
most common site of hematogenous spread
lung; (liver, brain, bone also common)
peak age with highest prevalence
60-70 y.o.
prevalence of endometrial cancer if
2-5%
Risk factors for endometrial cancer:
unopposed estrogen therapy, late menopause, PCOS, obesity, DM, HNPCC
protective factors for endometrial cancer:
combined OCPs (progestin); physical activity; pregnancy/breastfeeding; diet low in SF; smoking
Type II endometrial cancer histo types:
- papillary squamous
- clear cell
- adenosquamous
- undifferentiated
p53 mutations are most common in type __ endometrial cancer
type 2
PTEN mutations, MSI are most common in type __ endometrial cancer
type 1
mets found in peritoneum suggest type ___ endometrial cancer
type 2
mets found in the LNs and ovarian involvement suggest type __ endometrial cancer
type 1
type of endometrial cancer with a favorable prognosis
type 1
atypical endometrial hyperplasia is the precursor lesion for type ___ endometrial cancer
type 1; type 2 has less defined precursor lesion
type of endometrial cancer often with later onset (70s)
type 2; (type 1 presents in 50-60s)
leiomyosarcoma
rapidly growing fibroid, should be evaluated
MMMT
malignant mixed Mulerian tumor (carcinosarcoma)
3 other types of uterine cancer:
- leiomyosarcoma
- stromal sarcoma
- carcinosarcoma (MMMT)
symptoms of uterine cancer
- PMB
- PM endometrial cells on cervical cytology
- perimenopausal abnormal uterine bleeding (heavy or irregular)
- premenopausal w abnormal uterine bleeding w history of anovulation
PMB differential diagnosis includes:
- 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
precursor to endometrial cancer is _____ and presents as ____
endometrial hyperplasia and endometrial intraepithelial neoplasia (EIN); abnormal bleeding
benign irregular dilated glands (with or w/o atypia) indicate:
Simple endometrial hyperplasia or EIN
proliferation of glands with irregular outlines, back to back crowding of glands (w/ or w/o atypia)
Complex endometrial hyperplasia or EIN
43% of ______ endometrial hyperplasia harbor coexisting carcinoma
complex atypical hyperplasia
work-up of endometrial cancer involves:
endometrial biopsy (need tissue=90% sensitive) +/- TVUS; if negative, observe; D&C for more sensitive; + = pre-opp assessment
endometrial preoperative workup involves
labs, CT of abdomen/pelvis (if advanced disease suspected), CXR, EKG
stage of endometrial cancer in uterine corpus
Stage I (Ia 1/2 myometrium)
stage of endometrial cancer in uterine corpus and cervical stroma
stage II (does not go beyond uterus)
endometrial cancer in serosa/adnexa, vagina and para-aortic lymph nodes is stage:
stage III
endometrial cancer found in bladder/bowel mucosa and with distant mets is stage:
stage iv
5 year survival for endometrial cancer found in vagina and para-aortic LNs is:
52-60% (stage III)
5 year survival of stage IV endometrial cancer is:
14-17%; 3 % are diagnosed at this stage
5 year survival of this stage is 81-91%:
stage I (72% are diagnosed at this stage)
5 year survival of endometrial cancer found in cervix
71-78% (stage II)
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?
LN metastasis (40% decrease in 5 year survival and 6 fold higher recurrence rate); -all others are also prognostic factors
primary treatment of endometrial cancer is surgery or radiation?
surgery: hysterectomy/BSO/+-pelvic/paraaortic LND (PPLND)
primary radiation is indicated in endometrial cancer patients that:
cannot tolerate surgery (3-5% of patients)
