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RGU 2 > Endometrial Cancer > Flashcards

Endometrial Cancer Flashcards

1
Q

How do cancers spread?

A
  • LOCAL EXTENSION= grow into adjacent structures (bladder, rectum, peritoneal cavity).
  • LYMPHATIC (pelvic, para-aortic, groin lymph nodes).
  • HEMATOLOGIC= travel through blood to distant sites (lungs, brain, bone).
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2
Q

What is the number 1 risk factor for endometrial cancer?

A

obestity

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3
Q

What should you be sure to do when performing a physical exam for possible endometrial cancer?

A
  • speculum exam= look for normal vagina, normal cervix, no lesions.
  • pelvic exam= cannot appreciate uterine size or adnexa.
  • recto-vaginal exam= feel for normal sphincter tone, no blood, no mass, no nodularity.
  • endometrial biopsy.
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4
Q

What imaging modality would be helpful for a suspected endometrial cancer?

A
  • pelvic ultrasound
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5
Q

Can you do an endometrial biopsy in the office w/o anesthesia?

A

YES

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6
Q

What if your patient can’t tolerate the biopsy?

A

D&C +/- hysteroscopy (camera in the uterus)

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7
Q

Is post-menopausal bleeding cancer until proven otherwise?

A

YES

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8
Q

What would a SEROUS endometrial carcinoma (type II) look like?

A
  • papillary (finger-like) projections

* actually more common in the ovary, but when in the uterus, these are more aggressive.

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9
Q

What 2 genetic mutations put a woman at increased risk for endometrial cancer?

A
  1. Lynch syndrome (mismatch repair genes)

2. Cowden syndrome (PTEN)

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10
Q

In what age group does endometrial cancer occur most?

A
  • POSTmenopausal age
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11
Q

*** What are the 2 types of endometrial cancer?

A
  1. HYPERPLASIA (type I)= unopposed estrogen leading to endoMETRIOID histology because it looks a lot like the endometrium (age 50-60).
  2. SPORADIC (type II)= ATROPHIC endometrium (no evident precursor lesion and) driven by p53 MUTATION leading to SEROUS histology characterized by PAPILLARY structures (age greater than 70). Think “S” for Sporadic and Serous.
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12
Q

** Does type I or type II endometrial cancer have a better prognosis?

A
  • TYPE I
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13
Q

** With what is type I (hyperplasia) endometrial cancer related?

A
  • related to OBESITY/metabolic syndrome, and tamoxifen (SERM) use.
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14
Q

** With what is type II (sporadic) endometrial cancer related?

A
  • African Americans, HNPCC, and majority have metastasis.

* remember Serous or clear cell types.

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15
Q

What are some protective factors of type I (hyperplasia) endometrial cancer?

A
  • smoking

- oral contraceptive use

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16
Q

Are most endometrial cancers type I or type II?

A
  • type I (90%)
17
Q

What is the 5 year survival for a pt with type I endometrial carcinoma?

A
  • confined to uterus= 95%
  • lymph node mets= 67%
  • distant mets= 16%
18
Q

** How are uterine cancers staged? (TEST QUESTION)

A
  • SURGICALLY only.

* different from cervical cancer which is done via radiological studies or exam.

19
Q

What does total hysterectomy mean?

A
  • removal of only cervix and uterus.
20
Q

What procedure removes the fallopian tubes and ovaries?

A
  • bilateral salpingo-oophorectomy (BSO)
21
Q

From what artery does blood supply come to the uterus?

A
  • internal iliac artery
22
Q

What are the stages of uterine cancer (FIGO staging)?

A
  • Stage 1= confined to uterus
  • Stage 2= spread to cervix and stroma
  • Stage 3= spread to nodes
  • Stage 4= distant mets
23
Q

What adjuvant treatments are used for endometrial cancer after surgery, based on stage?

A
  • stage 1= nothing
  • stage 2= radiation
  • stage 3= chemo + radiation
  • stage 4= chemo
24
Q

What should you tell a patient who has type 1 (endometrioid) low grade uterine cancer?

A

they will have a good prognosis and if the cancer returns after treatment (which is unlikely), radiation will likely salvage and she’ll be ok.

25
Q

From where do uterine SARCOMAS (leiomyosarcoma) come?

A

myometrial layer

26
Q

*** Are leiomyomas (fibroids) common in women?

27
Q

** Are leiomyosarcomas common in women?

28
Q

** Is rapid uterine enlargement a specific symptom of uterine sarcoma (leiomyosarcoma)?

29
Q

Should you use power morcellators (device used to cut up large chunks of tissue into smaller pieces) to remove a uterine sarcoma (leiomyosarcoma)?

A

FDA says no.

- you should completely resect the malignancy.

30
Q

What is the prognosis for leiomyosarcoma?

A
  • not very good (stage 1= 66%).
  • adjuvant treatment (radiation or chemo after surgery) is NOT proven to reduce risk of recurrence.
  • oophorectomy does not impact prognosis.
31
Q

** What is the most common GYN cancer?

A

endometrial cancer

32
Q

** Does all post menopausal bleeding require evaluation?

RGU 2 (24 decks)

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