Endometrial Hyperplasia Beaton

Question 1

Endometrial CA that is only in the uterus is FIGO ___

Answer 1

1

Question 2

Endometrial CA that has extended to the cervix is FIGO ____

Answer 2

2

Question 3

What are the diagnostic modalities for endometrial hyperplasia?

Answer 3

Dilatation and curretage is the best but pipette biopsy may also be done. Pap smear is not very good by there may be an AGUS result (abnormal glandular cells of undetermined significance)

Question 3

What should you be thinking if a breast CA patient develops uterine bleeding?

Answer 3

They may be on tamoxifen which increases the risk for endometrial CA

Question 3

What are 3 major risk factors for endometrial cancer?

Answer 3

Early menarche, late menopause, and unopposed estrogen (chronic anovulation, extra-genital estrogen production)

Question 4

Endometrial CA that has pelvic extension is FIGO ____

Answer 4

3

Question 5

Why must you take endometrial hyperplasia so seriously?

Answer 5

It is essentially pre-cancer

Question 6

What is the usual presentation of endometrial hyperplasia?

Answer 6

irregular uterine bleeding and/or pelvic pain

Question 6

How does endometrial carcinoma spread vs. endometrial sarcoma?

Answer 6

endometrial carcinoma spreads via direct extension and lymph node mets; sarcoma spreads via hematogenous route

Question 7

At which FIGO stage do endometrial carcinoma cases become associated with significantly poorer survival rates and the need for an OB/GYN oncologist?

Answer 7

Stage II, Stage I has 75-90% survival and can be dealt with by normal OB/GYN

Question 9

What are 3 possible treatments for endometrial hyperplasia?

Answer 9

1) Hormonal i.e. progestin or low dose birth control to oppose the estrogen 2) D and C followed by hormonal and 3) Hysterectomy

Question 11

What hormonal issue are hyperplastic changes of the endometrium usually associated with?

Answer 11

Unopposed estrogen

Question 11

At what age do you begin to become much more concerned about irregular bleeding?

Answer 11

35

Question 12

What is the most common histologic type of endometrial carcinoma?

Answer 12

adenocarcinoma

Question 13

What are the 4 types of endometrial hyperplasia?

Answer 13

Simple without atypia, complex without atypia, simple with atypia, complex with atypia

Question 14

How does uterine sarcoma spread? When is prognosis very poor?

Answer 14

Hematogenous; if there is CA outside of the uterus

Question 16

How does tamoxifen increase the risk for endometrial CA?

Answer 16

It stimulates estrogen receptors on the endometrium (the opposite function that it has for the breast tissue) which can cause unopposed estrogen => endometrial hyperplasia => endometrial CA

Question 17

Why does endometrial CA happen so frequently in the ages of 50-59?

Answer 17

Because women begin to ovulate less frequently ( = no progesterone = unopposed estrogen) beginning in their thirties and eventually it can cause endometrial hyperplasia which is pre-cancer

Question 19

How should you view post-menopausal bleeding?

Answer 19

As endometrial carcinoma until proven otherwise

Question 20

Endometrial CA that has extended to the bladder or bowel wall or has distant mets is FIGO ____

Answer 20

4 the worst

Question 21

What are the treatments for endometrial carcinoma?

Answer 21

Surgery with external beam radiation and chemotherapy in recurrent cases

Question 22

What should you do on any woman over 35 with abnormal bleeding?

Answer 22

endometrial biopsy and dilatation and curettage