Endometrial Cancer

Question 1

Endometrial cancer

Answer 1

1 most common / curable GYN cancer in USA

Question 2

Risk factors for endometrial cancer

Answer 2

Unopposed estrogen (obesity, chronic anovulation, nullip, late menopause, exogenous unopposed estrogen, early menarche, tamoxifen use), also HTN / DM, HNPCC, breast Ca hx, BRCA 1

Question 3

Protective factors for endometrial cancer

Answer 3

OCPs, combination HRT, high parity, pregnancy, physical activity, smoking (weird)

Sx: postmenopausal / abnormal vaginal bleeding. can also see pelvic pain / mass / wt loss if advanced●Dx: endometrial biopsy → D&C (if suspicious findings on EMB)○Also get TSH, PRL, FSH as part of w/u; may also get CA-125 (if super high, maybe advanced), Pap○Pelvic U/S (postmenopausal should have endometrial stripe < 4-5mm). ■Even if normal endometrial stripe & pelvic U/S, need to get tissue (EMB/D&C)

Question 4

Subtypes of endometrial cancer

Answer 4

Younger women: type I, estrogen-dependent, more favorable prognosis.
Older thin white women: type II, non-estrogen dependent, less favorable
Most are endometriod adenocarcinoma, with complex atypical hyperplasia as precursor
Extension is direct to cervix / outward through myometrium → lymphatics eventually; heme less common

Question 5

What is the most important prognostic factor for endometrial cancer?

Answer 5

Grade is most important prognostic factor

Question 6

Staging of endometrial cancer

Answer 6

Stage I: Ia limited to myometrium, Ib/c into myometrium
Stage II: cervical invasion
Stage III: into serosa / peritoneum / vagina / pelvic or periaortic LN
Stage IV: invades bowel / bladder, or distant mets

Question 7

Treatment of stage I/stage II endometrial cancer

Answer 7

TAH-BSO (get rid of ovaries → less estrogen); may also need LN dxn and/or rads

Question 8

Treatment of stage III/stage IV endometrial cancer

Answer 8

TAH-BSO + radiation + pelvic / periaortic LN sampling
Advanced/recurrent: high dose progestins; ?chemo
Good 5 year survival!