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Week 33 (endometrial ca, PMB, Hyperplasia) > Endometrial Cancer > Flashcards

Endometrial Cancer Flashcards

1
Q

Stage I (A & B)

A

Tumor confined to the corpus utero
A:No or less than half myometrial invasion
B:invasion equal to or more than half of the myometrium

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2
Q

Stage II

A

Tumor invades cervical stroma but does not extend beyond the uterus

Endocervical glandular involvement is stage I

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3
Q

Stage 3 (I, II, III)

A

Local and/or regional spread of tumor
A:tumor invades the series and/or adnexae
B: vaginal and//or parametrial involvement
C: Mets to pelvic or parasitic lymph node
C1 positive pelvic nodes
C2 positive para-aortic lymph nodes with or withiout positive pelvic node

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4
Q

Stage 4 (A &B)

A

Tumor invades bladder and/or bowel mucosa and/or distant Mets
A: bladder and or bowel invasion
B: distant Mets, including intra-abdominal metastasis and/or inguinal lymph nodes

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5
Q

Pathophysiology of endometrial hyperplasia

A

Unopposed oestrogen stimulates endometrial cell growth by binding to estrogen receptors in the nuclei of endometrial cells

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6
Q

Risk factors for endometrial hyperplasia

A

BMI
Anovulation
Estrogen-secreting ovarian Rumours (granulosa cell tumours
Drug-induced endometrial stimulation (tamoxifen)
?immunosuppression

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7
Q

2 groups of endometrial hyperplasia

A
  1. Hyperplasia without atypia

2. Atypical hyperplasia

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8
Q

Risk of EH w/o atypia progressing to endo Ca

A

5% over 20 years
Majority will regress spontaneously during follow up
Treatment with progestogens has a higher disease regression rate

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9
Q

Progestogen treatment indications in EH w/o atypia

A

Women who fail to regrew following observation alone

Symptomatic women with AUB

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10
Q

First line medical treatment of EH without atypia

A

Continuous oral (10mg daily) or mirena (Mirena preferred) for 6 months

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11
Q

Follow up after treatment of EH

A

Endometrial biopsy after 6 months
6 monthly intervals
Need two negative samples before can discharge
If obese, still should have yearly biopsy after two negative 6 monthly
Mirena usually left in situ
Oral progestogens only used for 6 months

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12
Q

If EH persists for 12 months despite treatment, what to do

A

Chance of disease regression low

Therefore, proceed to hysterectomy as cancer risk higher

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13
Q

When is surgical mama garment appropriate for women with endometrial hyperplasia?

A
  • progression to atypical hyperplasia occurs during f/u
  • no histological regression of hyperplasia despite 12 months of treatment
  • there is relapse of EH after completing progestogen tx
  • there is persistence of bleeding symptoms
  • woman declines to undergo surveillance or comply with medical treatment
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14
Q

When to take ovaries in EH without atypia

A

Postmenopausal women

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15
Q

What should the initial management of atypical hyperplasia be?

A

Total hysterectomy

With BSO if post menopausal

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16
Q

How should women with atypical hyperplasia who wish to preserve their fertility or who are not suitable for surgery be managed?

A
  • counsel around underlying risk of malignancy
  • investigations should aim to rule out invasive EC or co-existing ovarian cancer
  • MDM review
  • Mirena 1st line, oral progestogens second
  • once fertility no longer required, offer hysterectomy again in view of high risk of disease relapse
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17
Q

How should women with atypical hyperplasia not undergoing hysterectomy be followed up?

A

3 monthly pipelles until two negative

Then every 6-12 months until hysterectomy

18
Q

How should endometrial hyperplasia be managed in women wishing to conceive?

A

Disease regression on one sample prior to trying
Refer to fertility specialist
ART to be considered as birth rate higher and may prevent relapse compared to natural conception
Prior to ART, should have regression of EH as associated with higher preg rates

19
Q

HRT and EH

A
  • need progestogen component if have uterus
  • report any vaginal bleeding
  • if have EH and taking HRT, need mirena or progestogen
20
Q

What is the risk of deveoping EH on adjuvant treatment for breast cancer

A 
Increased risk with tamoxifen
Aromatase inhibitors (anastrazole, exemestane and letrozole) not known to increase risk
21
Q

Incidence of endometrial hyperplasia

A

28:100000

22
Q

Peak age of endometrial ca incidence

A

60-79

23
Q

Risk factors for endometrial ca

A 
Older age
Late menopause (over age 52)
Nulliparity
Obesity
Oestrogen only HRT
PCOS
DIabetes
Insufficient physical activity
Family hx lynch syndrome
24
Q

Protective factors against endometrial ca

A

Cigarette smoking
COC
Coffee intake
Exercise

25
Q

Percentage of endometrial ca that is preventable

A

34%

26
Q

Percentage of women with PMB that have cancer

A

10%

27
Q

Percentage of polyps associated with endometrial hyperplasia

A

10%

28
Q

Simple hyperplasia histo

A

Cystic and branching patterns

29
Q

Complex hyperplasia

A

Crowded or closely opposed glands

30
Q

Atypical histo

A

Nuclear atypia and hyperplasia

31
Q

Type I endometrial cancers

A

Endometriod
Typically low grade
Good prognosis
Oestrogen-driven pathway

32
Q

Type II endometrial cancers

A

Typically serous
May also be clear cell, mucinous, squamous, and sarcoma
Not oestrogen driven
Precursor lesion:serous endometrial intraepithelial carcinoma (p53 mutation)

33
Q

Prognostic factors for endometrial cancer

A 
Cell type
Grade
Degree of myometrial invasion
Lymphovascular space invasion
Positive peritoneal washings
Age of patient
DNA aneuploidy
Mets
34
Q

When can use RT in endometrial ca

A

Adjuvant RT to treat pelvic nodes and vault
Stage 2 w/ cervical involvement
Stage 3 disease or higher
Palliative RT for stage IV
Palliative RT for recurrence (local)
Primary curative tx in those unfit for surg

35
Q

Risk of nodal disease in Stage II disease

A

14-10%

36
Q

With recurrence, risk of mortality, local recurrence and distant recurrence

A

33% mort w/in 5 years
50% local
29% distant

37
Q

Types of uterine sarcomas

A

Carcinosarcomas
Leiomyosaromas
Endometrial stromal sarcomas

38
Q

Percentage of concomitant carcinoma in patients undergoing hysterectomy

A

22-43%

39
Q

Percentage of EH withOUT atypia that spontaneously resolve

A

80%

40
Q

Regression rates of EH with atypia and mirena

A

Up to 86% (meta-analysis)

41
Q

False negative rate of pipeline

A

10-15%

42
Q

Recurrence timeframe

A

75% w/in 1 year

85% wi/in 2 years

Week 33 (endometrial ca, PMB, Hyperplasia) (5 decks)

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