endometrial + cervical

Question 1

epi endometrial

Answer 1

54k cases annual, 10k deaths; estrogen driven tumor, obesity is increasing rate in developed world. DM also risk factor

Question 2

genetics of endometrial

Answer 2

HNPCC, often the sentinel event for HNPCC. at MSKCC, do MMR IHC on tumor if <60y. endometrial has aberrency in PI3K/AKT

Question 3

endometrial cancer staging

Answer 3

FIGO 2009: stage I- confined A50%, II-invading cervical stroma; III-regional spread; IV-distant

Question 4

most common endometrial cancer

Answer 4

endometrioid: FIGO grade 1,2,3

Question 5

serous carcinoma endometrium

Answer 5

automatically high risk

Question 6

adjuvant therapy for endometriod endometrial stage I

Answer 6

EBRT does not improve survival but reduces QOL. if higher risk, then give brachytherapy to spare the toxicities

Question 7

risk factor for endometrial

Answer 7

age, grade 2/3, LVI, outer 1/3 myometrial invasion

Question 8

chemotherapy for endometrial?

Answer 8

high risk stage I- no OS benefit with chemo shown compared to EBRT

Question 9

stage III/IV with no residual endometrial, adjuvant therapy?

Answer 9

OS benefit of chemotherapy carbo/taxol. differences not large, but real. less toxic than pelvic RT

Question 10

hormones for endometrial cancer

Answer 10

response rate to hormones but 10-30% but duration of response 1-3month. its an option but short benefit. Menace approved!

Question 11

initial chemo for metastatic endometrial

Answer 11

TAP (cis/dox/taxol) v. dox/cis–> 2 months OS of the combination. However then compared to taxol/carbo–>same OS. Taxol/carbo is now standard.

Question 12

cervical cancer epi

Answer 12

12k annual USA, 4k deaths. almost all HPV+ 16,18.

Question 13

cervical screening guideliens

Answer 13

start at 21, every 3 years, if get PCR the can test every 5 years

Question 14

cervical ca types

Answer 14

75% SCC, 20% adeno

Question 15

cervial ca staging

Answer 15

I- confined, II-beyond but not to wall or lower third of vagina; IIb- with invasion parametrial (NOT operable). ALL curable except IVb (distant met).

Question 16

treatment cervical ca stage I-IIa

Answer 16

radical hysterectomy, dissect side-walls, upper third of vagina, proximal uter osacral ligament, en bloc, regional . LN. high risk-pelvic parametrium/LN, or margins-need concurrent chemo/RT.

Question 17

stage IIb/IV- parametrical invovlement cervical

Answer 17

primary chemo/RT (weekly cis x 6 with definitive RT) with external and intracavitary bratty with RT to 85Gy to point of cancer in order to cure. If you miss appointment, the cure is lower.

Question 18

advanced cervical Ca (Stage IVb or recurrent)

Answer 18

all platinum doublet is the same, so the standard is cis/taxol, plus bev gives higher survival 17 v. 13 months OS.