Endometrial Cancer Flashcards
What is the most common Gyn malignancy?
Endometrial CA
What is the genetic issue with HNPCC (lynch syndrome)? What is the role of this with endometrial cancer?
AD impaired DNA mismatch repair
Increases the risk for endometrial CA
True or false: endometrial CA is primarily a tumor in postmenopausal women
True
What ages usually have endometrial CA?
58-62
True or false: less than 40 or over 70 have poor prognosis with endometrial CA
True
What is the associated with endometrial CA?
Prolonged uninterrupted estrogen exposure
What is the pathophysiology of endometrial CA?
Uncontrolled estrogen stimulation causes proliferation of endometrial cells
What are the cytological appearances with endometrial CA?
Cyto atypia with loss of cellular polarity and chromatin clumping
Why is nulliparity a risk factor for the development of endometrial CA?
Lack or progesterone, and prolonged estrogen exposure
What is the major side effect with tamoxifen therapy?
Endometrial CA
What decreases the risk of endometrial CA? (3)
Ovulation
Progestin therapy
Multiparity
True or false: obesity is a risk factor for the development of endometrial CA
True
What is the most common type of uterine CA?
Adenocarcinoma
How do adenocarcinomas progress?
Invades the endometrial stroma, and penetrate the myometrium and invasion of myometrial lymphatics
What are the common lymph nodes that get mets from adenocarcinoma of the uterus?
Pelvic
Paraaortic
Inguinal nodes
What are the histological characteristics of secretory endometrium?
Glands present with a saw-tooth pattern
True or false: with simple hyperplasia, there is a regular gland to stromal ratio
True
What is the typical adenocarcinoma histologic appearance?
“back to back glandular appearance” with nuclear atypia
How common are endometrial polyps?
Fairly common
What are sonohysterograms?
A technique in which fluid is injected through the cervix into the uterus, and ultrasound is used to make images of the uterine cavity. The fluid shows more detail of the inside of the uterus than when ultrasound is used alone
What is the general management for endometrial hyperplasia if simple? Complex?
Simple = progesterone therapy
Complex = hysterectomy
What endometrial tissue thickness is concerning for postmenopausal women?
More than 4 mm
What is advanced imaging of the pelvis particularly indicated?
If there is evidence of endometrial cancer
What are the treatments for endometrial cancer?
Total abdominal hysterectomy and removal of tubes + ovaries
What is the medical treatment for endometrial cancer in the case of poor surgical candidates?
XRT or progesterone
What are the routes through which endometrial cancer usually mets?
Local extension and lymphatics
Rare hematogenous spread
What is the risk for endometrial cancer with postmenopausal bleeding?
20% ish
What percent of endometrial cancers present with postmenopausal bleeding?
90%
What, besides postmenopausal bleeding, are the s/sx of endometrial cancer?
- Lower abdominal pain
- Hematuria
- Frequency
- Rectal bleeding
- hip or back pain
What are the three modalities for assessing abnormal uterine bleeding?
- Endometrial bx
- US (saline sonohysterogram)
- Hysteroscopy D&C
What are the four aspects of pretreatment eval for endometrial CA?
- PE
- Endometrial sampling
- Blood work
- CXR
What are the two most critical factors for the prognosis of endometrial cancer?
Grade and histology
What is the 2nd most critical prognostic factor of endometrial CA?
Depth of myometrial invasion
What are the important surgical prognostic factors?
Histological type
What is the treatment failure of papillary adenoCA?
32%
What is the treatment failure of serous papillary adenoCA?
63%
What is the importance of depth of myometrial spread with uterine cancer?
Risk of lymph node spread, treatment failure, and death from disease
How common are uterine sarcomas?
Less than 5% of uterine malignancies
Sarcomas usually arise from what type of tissue?
Muscles
What are uterine sarcomas?
Tumors arising from myometrium or stromal components
What is the prognosis for uterine sarcomas?
Bad
How common is fallopian tube cancer?
Super Rare (0.41/100,000)
What are the primary risk factors for fallopian tube cancer? Associated risk factors?
- BRCA1 and BRCA2
- Infertility and low parity
Fallopian tube cancers are mostly of what type?
Adenocarcinomas
What is hydrops tubae profluens?
Intermittent expulsion of clear or serosanguinous fluid from the vagina
What is Latzko’s triad?
S/sx of tubal CA:
- Intermittent serosanguineous d/c
- Colicky pain
- Mass
Why is there an increased risk of endometrial cancer with PCOS?
Less frequent ovulation means that there is an increase in estrogen exposure
How does birth control decrease the risk of endometrial cancer?
Lower estrogen amount, and increase progesterone
