Endometrial Hyperplasia and CA

Question 1

what is the relationship between endometrial thickness and risk of endometrial CA?

Answer 1

increased thickness increases risk

Question 2

t or f: endometrial hyperplasia is considered a precancerous condition

Answer 2

TRUE

Question 3

which type of endometrial hyperplasia has the highest likelihood of professing to CA?

Answer 3

complex atypical hyperplasia (noting that atypical hyperplasia is more likely to progress to CA in older women than in those younger)

Question 4

what is the gold standard diagnostic test for endometrial CA?

Answer 4

biopsy of the endometrium

Question 5

women with this syndrome have a 40-60% lifetime risk of developing endometrial CA which is equal to their risk of developing colorectal CA

Answer 5

Lynch Syndrome (hereditoary nonpolyposis colorectal CA)

Question 6

what are some of the side effects of progestin?

Answer 6

WTHEH: weight gain, thrombophlebitis, headache, edema, HTN

Question 7

t or f: endometrial CA is the most gynecologic CA in the US

Answer 7

TRUE : should be followed by cervical and then ovarian

Question 8

t or f: endometrial CA is often diagnosed in its early stages

Answer 8

TRUE - it often presents with obvious symptoms

Question 9

what are the two types of endometrial CA? which is more common?

Answer 9

type I (more common) - dependent on estrogen that begins as proliferation of normal tissue; type II is unrelated to estrogen or hyperplasia and and tends to present both as higher grade and more aggressive

Question 10

what is the mainstay of treatment for mostly all the different types of endometrial hyperplasia?

Answer 10

cyclical progestin therapy; it progresses to continuous progestin as the severity increases and eventual hysterectomy if need be.

Question 11

which symptom is present 90% of the time for endometrial CA?

Answer 11

abnormal bleeding

Question 12

t or f: pap smears are diagnostic for endometrial CA

Answer 12

FALSE

Question 13

what are some differential diagnoses for endometrial CA?

Answer 13

endometrial hyperplasia, exogenous estrogen, endometrial polyps/cervical polyps, coagulopathy.

Question 14

t or f: liver disease is a risk factor for endometrial CA?

Answer 14

TRUE (b/c a healthy liver is thought to be able to metabolize estrogens)

Question 15

what are some risk factors for endometrial CA?

Answer 15

obesity, early menarche/late menopause, PCOS, DM, HTN, tamoxifen tx for breast CA

Question 16

what is the diagnostic TOC for evaluation of post menopausal bleeding?

Answer 16

endometrial biopsy and D&C hysteroscopy of bx is not adequate

Question 17

of what histologic subtype are most endometrial cancers?

Answer 17

endometroid

Question 18

t or f: hyperplasia without atypia has the same risk of progressive to CA as hyperplasia with atypia

Answer 18

FALSE: much lower without atypia

Question 19

how is endometrial CA staged?

Answer 19

clinically (and again, as the stages increase in number the more widespread/invasive the CA is)

Question 20

what is the most important prognosticator in endometrial CA?

Answer 20

grade

Question 21

in comparison to G1, is G3 more or less well differentiated?

Answer 21

LESS (IOW, poorly differentiated)

Question 22

what is the basic treatment for all stages of endometrial CA?

Answer 22

TAH, BSO

Question 23

adjuvant chemo includes doxorubicin and cisplatin - what are some common side effects of these drugs?

Answer 23

dox: cardiotoxicity; cis: nephrotoxicity

Question 24

pt presents with rapidly enlarging mass with bleeding - what’s the diagnosis?

Answer 24

VERY RARE - but uterine sarcoma (less than 1% of fibroids progress to CA)

Question 25

t or f: leiomyosarcomas are approx. 1/3 of all uterine sarcomas

Answer 25

TRUE