Endometrial Cancer/ Cervical cancer. Flashcards
risk factors for endometrial carcinoma
- increasing age
- estrogen (estrogen therapy, nulliparity, late menopause)
- obesity
- polycystic ovary syndrome
- diabetes
- HNPCC
- tamoxifen therapy.!!
types of endometrial cancer
Type 1 = Endometrioid -estrogen dependent
- most common
- favorable prognosis
Type 2 - non-estrogen dependent - 4 types
- worse prognosis
- p53 mutations common.
- papillary serous
- clear cell
- adenosquamous
- undifferentiated
symptoms of endometrial carcinoma
1 most common presenting symptom = post-menopausal bleeding!!!
also. ..
- postmenopausal endometrial cells on cervical cytology
- abnormal uterine bleeding - irregular/heavy menses
- abnormal uterine bleeding with history of anovulation
T/F Endometrial cancer is staged surgically
True!
Endometrial and ovarian cancer is staged surgically - while cervical cancer is staged clinically.
how is endometrial cancer usually spread?
Through direct extension ALSO transtubal (goes to fallopian tubes) -lymphatic - pelvic, then para-aortic nodes -blood - rare.
Most common gynecologic cancer
endometrial cancer
When does endometrial cancer happen, typically?
-60-70 years old.
what is the precursor to type 1 endometrial cancer?
-atypical endometrial hyperplasia
what is the precursor to type 2 endometrial cancer?
there isn’t one.
What is the #1 cause of post menopausal bleed?? Hint - not endometrial cancer
atrophic endometritis/ vaginitis from low estrogen state.
What is the difference between Simple and Complex Endometrial hyperplasia?
Simple or complex refers to architecture.
LESS important than if atypia is present (atypia is much more related to progression to cancer)
-only the “atypic” varieties of both of these confer significantly increased risk of cancer progression.
Workup for a pt suspected to have endometrial cancer
Endometrial biopsy!!
-can do a transvaginal ultrasound along with it or not. BUT always do the biopsy. it is 90% sensitive.
If an endometrial biopsy comes back positive, what is the next step?
-evaluate for surgery.(labs, CT scan to detect advanced disease, CXR, EKG)
how do positive lymph nodes affect staging in endometrial cancer?
-positive nodes change it from stage 2 to stage 3
T/F - most endometrial cancer is detected at stage 2 or later.
FALSE.
72% of endometrial cancer is detected at stage 1
What is the most important predictor of survival in endometrial cancer?
stage/histologic type
What is the most important predictor of recurrence rate in early endometrial cancer?
lymph node metastasis
Treatment for endometrial cancer
-primary treatment is surgery.
remove uterus (hysterectomy) + remove ovaries (high risk of metastasis) = BSO - bilateral salpingo oophorectomy
-lymph node dissection may also be done
-radiation for those who can’t tolerate surgery
-adjuvant treatment depends on pathologic risk factors.
Post-op follow up for endometrial cancer
similar to cervical cancer. Everyone can recur, and it usually happens in the first 2 years.
-clinical exam every 3-4 months for 2 years, every 6mo for 3 years, then yearly after 5 yrs.
T/F - recurrence is quite fatal in endometrial cancer.
False. It is quite fatal in cervical cancer. But 80% of recurrences are cured in endometrial cancer
T/F - biopsy/endometrial sampling is needed for diagnosis of endometrial cancer.
true.
T/F - Pap smears can reduce incidence of cervical cancer by 70%
true
T/F: 75% of cervical cancer occurs in developing countries.
true
T/F: infection with HPV 16 almost invariably leads to cancer.
False. High risk HPV infection is necessary but insufficient for cervical cancer.
these strains of HPV cause warts
6 and 11
risk factors for cervical cancer (besides HPV)
- immunocompromised
- smoking
- multiple partners
- low Socioeconomics
This type of cancer makes up 80% of cervical cancers.
Squamous cell carcinoma
adenocarcinoma 2nd most common
Recommendations for Pap smear screening
- start at age 21.
- every three years from 21-65 years old.
exceptions: HIV, immunocompromised, or previously had cervical cancer
pathogenesis of cervical neoplasia
almost exclusively due to HPV.
how is cervical cancer staged?
clinically (physical exam/rectovaginal exam/chest Xray, etc)
What is the usual pattern of spread for cervical cancer? How does this affect treatment options
Most often, it spreads/ invades locally.
It can also spread via lymphatics
-hematogenous/intraperitoneal spread is rare.
Pros and cons of surgery vs. radiation for early stage cervical cancer.
Surgery -preserves ovarian fxn -you get histology information But.. -surgery has risks/morbidity -may also need radiation after surgery anyway.
Radiation:
-no surgery, done as an outpatient treatment
But…
-permanent ovarian failure (radiation kills em)
-permanent bowel issues.
-risk of bowel and bladder fistulae, strictures
what does CIN stand for?
Cervical intraepithelial neoplasia. It is a precursor to cervical cancer (30% probability of becoming cancer if untreated)
T/F The HPV vaccine has been readily accepted in the US, vaccination rates for girls 13-17 are >90% now.
False. Only 33% of girls get the full series.
Even lower for boys.
symptoms of cervical cancer
(usually not present until late)
- abnormal bleeding (between periods, with intercourse, after menopause)
- vaginal discharge
- leg pain/ pelvic pain with advanced disease
T/F: biopsy is needed for disagnosis of cervical cancer.
true
Treatment for the different stages of cervical cancer.
Stage determines treatment!
Early (1-1B1 - very small tumor) = radical hysterectomy with lymph node dissection, OR chemoradiation
Locally advanced = primary chemoradiation
Metastatic disease = systemic chemotherapy
Is it possible to get pregnant again after treatment for cervical cancer?
Yes - they can do a “radical trachelectomy” - removing cervix, reattaching uterus to the vagina! 70% can get pregnant after this.
Describe Post-surgery surveillance for cervical cancer
appointments / physical exam (ROS, lymph nodes, pelvic exam)
- every 3 mo for 2 years
- every 6 mo for 3 years.
- annually after 5 years.
- From the beginning, pap smear and chest x ray yearly.
describe recurrence rates for cervical cancer
80% of recurrences occur in 2 years.
- overally poor prognosis for these patients.
- The higher the stage, the higher the recurrence and the higher mortality.
