ENDOMETRIAL CANCER (SB) Flashcards
What is the most common malignancy of the lower female genital tract in the US?
Endometrial cancer
What is the order of common gynecologic malignancies in the US?
1st: Endometrial cancer, 2nd: Ovarian cancer, 3rd: Cervical cancer
What is the most common gynecologic malignancy in the Philippines?
Cervical cancer
In which age group is endometrial cancer most frequently diagnosed?
50-65 years old
What percentage of endometrial cancer cases are diagnosed in women under 40?
Approximately 5%
What percentage of endometrial cancer cases are diagnosed in women under 50?
10-15%
What other cancer are women diagnosed with endometrial cancer under 50 at risk for?
Synchronous ovarian cancer
What condition results from increased estrogenic stimulation and is a precursor to endometrioid endometrial cancer?
Complex atypical hyperplasia
What type of endometrial cancers develop without previous hyperplasia and tend to be more aggressive?
Non-estrogen-related carcinomas (e.g., serous histology)
What is a major risk factor for endometrial cancer?
Anovulation
How does obesity contribute to endometrial cancer risk?
Peripheral cholesterol is converted to estrogen, leading to unopposed estrogen stimulation
Name a medication that increases the risk of endometrial cancer.
Tamoxifen
List three factors that increase the risk of endometrial cancer.
Unopposed estrogen stimulation, obesity, nulliparity
List three factors that decrease the risk of endometrial cancer.
Ovulation, progestin therapy, combination oral contraceptives
What is the classification system used for endometrial hyperplasia?
World Health Organization (WHO) classification
Name the four types of endometrial hyperplasia.
Simple, Complex, Atypical Simple, Atypical Complex
What is the most frequent symptom of endometrial hyperplasia?
Abnormal uterine bleeding (AUB)
What diagnostic tool is used to evaluate endometrial thickness in endometrial hyperplasia and cancer?
Transvaginal ultrasonography (TVS)
What is the endometrial thickness cutoff for postmenopausal women?
0.3 cm
What is the management for simple hyperplasia without atypia and no abnormal bleeding?
Observation
What is the first-line treatment for endometrial hyperplasia with atypia in reproductive-age women who wish to preserve fertility?
High-dose progestin therapy (e.g., megestrol acetate 40 mg 3-4x daily)
What is the preferred treatment for postmenopausal women with complex atypical hyperplasia?
Hysterectomy
What is the effect of progesterone therapy on the endometrium?
Thins out the endometrium and induces sloughing
How do you assess response to progesterone therapy in endometrial hyperplasia?
Resolution of abnormal bleeding
When should endometrial sampling be repeated after initiating treatment for hyperplasia?
3-6 months
What are the primary symptoms of endometrial carcinoma?
Postmenopausal bleeding, abnormal premenopausal bleeding, and perimenopausal bleeding
What is the diagnostic method for endometrial carcinoma?
Histologic examination of the endometrium
What is the initial diagnostic procedure for endometrial carcinoma?
Office endometrial biopsy
What procedure can be performed if endometrial carcinoma is found to rule out invasion of the endocervix?
Endocervical curettage
What percentage of endometrial carcinoma cases can be detected by Pap smear?
Approximately 50%
What are the three histologic grades of endometrial carcinoma?
Grade 1: Well differentiated, Grade 2: Intermediate differentiation, Grade 3: Poorly differentiated
How is the grading of endometrial carcinoma determined?
By the percentage of solid components in the tumor
What are the percentages of solid components for each grade of endometrial carcinoma?
Grade 1: <5%, Grade 2: 6-50%, Grade 3: >50%
Name three types of endometrial adenocarcinoma.
Typical endometrioid adenocarcinoma,
Adenocarcinoma with squamous elements,
Clear cell carcinoma
What are the four major histologic types of endometrial carcinoma?
Endometrioid adenocarcinoma, Serous carcinoma, Clear cell carcinoma, Mucinous carcinoma
What is Stage I endometrial carcinoma?
Cancer is confined to the uterus
What is Stage II endometrial carcinoma?
Cancer has spread to the cervix
What is Stage III endometrial carcinoma?
Cancer has spread to the lymph nodes or pelvic wall
What is Stage IV endometrial carcinoma?
Cancer has metastasized beyond the pelvis
Which clinical factor is associated with a worse prognosis in endometrial carcinoma?
Older age at diagnosis
How does race affect survival rates in endometrial carcinoma?
White patients have a higher survival rate than Black patients; Black women are more likely to develop uterine serous cancers
What is the most important pathologic factor determining prognosis in endometrial carcinoma?
Tumor grade
What histologic type of endometrial carcinoma has the best prognosis?
Well-differentiated endometrioid adenocarcinoma
What histologic types of endometrial carcinoma have a poor prognosis?
Serous carcinoma, clear cell carcinoma, poorly differentiated carcinoma
How does tumor size affect prognosis in endometrial carcinoma?
Larger tumors are associated with worse prognosis
What does deep myometrial invasion correlate with?
Increased risk of tumor spread outside the uterus
Which lymphatic drainage sites are most important clinically in endometrial carcinoma?
Pelvic and paraaortic lymph nodes
What are the four major channels of lymphatic spread in endometrial carcinoma?
- Round ligament to inguinal femoral nodes,
- Tubal branches,
- Ovarian pedicles to paraaortic nodes,
- Broad ligament to pelvic nodes
What are the most common sites of distant metastases in endometrial carcinoma?
Lungs, retroperitoneal lymph nodes, abdomen
What imaging studies are used to evaluate for metastases in endometrial carcinoma?
Chest X-ray, chest and abdominal pelvic CT scan
What tumor marker can be elevated in endometrial carcinoma?
CA 125
In which type of endometrial carcinoma is CA 125 particularly useful?
Serous carcinoma
What is the primary treatment for Stage I endometrial carcinoma?
Surgery: hysterectomy, bilateral salpingo-oophorectomy, pelvic cytology, bilateral pelvic and paraaortic lymphadenectomy
What are the exceptions to surgical treatment in Stage I endometrial carcinoma?
Young premenopausal women desiring fertility, Stage I Grade 1 endometrial carcinoma associated with hyperplasia, Women with high surgical risk
Does postoperative adjuvant radiation improve overall survival in endometrial carcinoma?
No
What treatment options are considered for high-stage or recurrent endometrial carcinoma?
Multimodality approach: chemotherapy, radiation, hormonal therapy
What percentage of uterine malignancies are sarcomas?
Less than 5%
What is the difference between homologous and heterologous uterine sarcomas?
Homologous sarcomas resemble normal uterine mesenchymal tissue; heterologous sarcomas resemble foreign tissues
Name three types of homologous uterine sarcomas.
Leiomyosarcoma, Endometrial stromal sarcoma (ESS), Angiosarcoma
Name three types of heterologous uterine sarcomas.
Rhabdomyosarcoma, Chondrosarcoma, Osteosarcoma
What is another name for carcinosarcoma?
Malignant mixed müllerian tumor
What is the primary treatment for uterine sarcoma?
Surgical removal of the uterus, tubes, and ovaries
What is the role of chemotherapy in metastatic uterine sarcoma?
Multiagent chemotherapy is used, but complete responses are rare and usually temporary
