Endometrial Intraepithelial Neoplasia

Question 1

What is the risk of progression to endometrial cancer with SIMPLE HYPERPLASIA?

Answer 1

1%

Question 2

What is the risk of progression to endometrial cancer with COMPLEX HYPERPLASIA?

Answer 2

3%

Question 3

What is the risk of progression to endometrial cancer with SIMPLE ATYPICAL HYPERPLASIA?

Answer 3

8%

Question 4

What is the risk of progression to endometrial cancer with COMPLEX ATYPICAL HYPERPLASIA?

Answer 4

29%

Question 5

What is the average time to endometrial cancer in a patient with persistent hyperplasia?

Answer 5

6 years

Question 6

Endometrial Intraepithelial neoplasia (EIN) is also known as?

Answer 6

Atypical hyperplasia

Question 7

Risk of coexisting cancer in a patient with EIN ?

Answer 7

40%

Question 8

Risk of progression to endometrial cancer with EIN?

Answer 8

30%

Question 9

What is the best procedure to confirm endometrial malignancy or exclude cancer?

Answer 9

Hysteroscopy and D&C

Question 10

What percentage of the endometrium does an EMB sample?

Answer 10

15%

Question 11

At what endometrial thickness should an EMB or sampling be done in a postmenopausal patient with PMB?

Answer 11

> 4mm

Question 12

At what endometrial thickness should an EMB or sampling be done in a postmenopausal patient without PMB?

Answer 12

> 11mm

Question 13

an EMS > 11 mm correlates with what percent risk of endometrial cancer?

Answer 13

6%

Question 14

What is the dose and regimen for Megace (Megesterol) therapy for endometrial hyperplasia?

Answer 14

40 - 200 mg/day

Question 15

What is the dose and regimen for Provera (Medroxyprogesterone acetate)

Answer 15

10 - 20 mg/day 12-14 day OR cyclic 12-14 days per month

Question 16

What is the best form of progesterone to give a patient with endometrial hyperplasia?

Answer 16

Mirena IUD

Question 17

What is the general frequency of EMB follow up for a patient with hyperplasia without atypia?

Answer 17

EMB q 3-6 months

Question 18

Management of patient with regression of hyperplasia following hormonal therapy?

Answer 18

re-biopsy if repeat bleeding

Question 19

Management of patient with persistence of hyperplasia following IUD placement?

Answer 19

add on oral progesterone

Question 20

Management of patient with progression to atypia (EIN) following hormonal management?

Answer 20

Hysterectomy

Question 21

Rate of regression in patient with hyperlasia w/o atypia following hormonal management?

Answer 21

86%

Question 22

Rate of relapse following regression in a patient with hyperlasia w/o atypia following hormonal management?

Answer 22

26%

Question 23

What is the most common GYN cancer in the US?

Answer 23

Endometrial

Question 24

Greatest risk factor for type 1 endometrial cancer?

Answer 24

unopposed estrogen

Question 25

What is the risk of developing endometrial cancer for a patient with LYNCH syndrome?

Answer 25

increased up to 60%

Question 26

What type of genetic mutation is associated with LYNCH syndrome?

Answer 26

Missmatch repair genes

Question 27

What genes are involved with LYNCH syndrome?

Answer 27

MLH1, MSH2, PMS2, MSH6

Question 28

What gene mutations are associated with Cowden disease?

Answer 28

PTEN mutations

Question 29

BRCA1 increases the risk of which type of endometrial cancer?

Answer 29

Type 2

Question 30

When should a CT scan be used in the evaluation of a patient with endometrial cancer?

Answer 30

To evaluate for advanced/Metastatic disease

Question 31

When should a MRI be used in the evaluation of a patient with endometrial cancer?

Answer 31

used in the pretreatment evaluation to determine myometrial invasion

Question 32

Following which pap smear results should an EMB be preformed?

Answer 32

1. IF AGS/ AGUS do EMB in a patient > 35yrs or with significant risk factors for endometrial hyperplasia 2. IF atypical endometrial cells seen on pap smear 3. If endometrial cells seen on pap in post menopausal woman

Question 33

When should an EMB be performed in a patient < 45 yrs old?

Answer 33

Persistent abnormal bleeding with risk factors including obesity, anovulation

Question 34

When should an EMB be performed in a patient 45 yrs - Menopause?

Answer 34

If cycles are < 21 days, intermestrual bleeding, heavy or prolonged bleeding

Question 35

When should an EMB be performed in a patient who is postmenopausal?

Answer 35

any spotting or vaginal bleeding with EMS > 4 mm

Question 36

True or false: Routine imaging to evaluate for metastases in a patient with endometrial cancer is not recommended

Answer 36

True

Question 37

What type of uterine cancer is associated with type 1?

Answer 37

Endometriod

Question 38

What mutation is associated with type 1 uterine cancer?

Answer 38

PTEN

Question 39

True or false: Most Type 1 uterine cancers are diagnosed at late stage?

Answer 39

False

Question 40

What is the survival rate in type 1 uterine cancer?

Answer 40

85%

Question 41

True or false: Type 1 uterine cancer is not associated with unnoposed estrogen?

Answer 41

False

Question 42

What type of uterine cancer is associated with type 2?

Answer 42

Clear cell, pap serous

Question 43

What mutation is associated with type 2 uterine cancer?

Answer 43

TP53, BRCA1

Question 44

True or false: Most Type 2 uterine cancers are diagnosed at late stage?

Answer 44

True

Question 45

What is the survival rate in type 2 uterine cancer?

Answer 45

50%

Question 46

True or false: Type 2 uterine cancer is not associated with unnoposed estrogen?

Answer 46

True

Question 47

Serous uterine cancer accounts for what percentage of uterine cancer?

Answer 47

10%

Question 48

Clear cell uterine cancer accounts for what percentage of uterine cancer?

Answer 48

3%

Question 49

Which types of uterine cancer account for the highest proportion of uterine cancer related deaths?

Answer 49

Serous

Question 50

Definition of grade 1 uterine cancer?

Answer 50

< 5% non morular/solid growth pattern

Question 51

Definition of grade 2 uterine cancer?

Answer 51

6 - 50% non morular/solid growth pattern

Question 52

Definition of grade 3 uterine cancer?

Answer 52

> 50% non morular/solid growth pattern

Question 53

Definition of stage IA uterine cancer?

Answer 53

< 50% myometrial invasion

Question 54

Definition of stage IB uterine cancer?

Answer 54

>50% myometrial invasion

Question 55

Definition of stage II uterine cancer?

Answer 55

Tumor invades cervical stroma

Question 56

Definition of stage IIIA uterine cancer?

Answer 56

Tumor invades UP. Uterine serosa or adnexa

Question 57

Definition of stage IIIB uterine cancer?

Answer 57

Tumor invades DOWN. Vaginal or parametrial involvement

Question 58

Definition of stage IIIC uterine cancer?

Answer 58

Tumor invades NODES

Question 59

Definition of stage IIIC1 uterine cancer?

Answer 59

Tumor invades NODES. Pelvic nodes

Question 60

Definition of stage IIIC2 uterine cancer?

Answer 60

Tumor invades NODES. Para aortic

Question 61

Definition of stage IVA uterine cancer?

Answer 61

Tumor invades bladder or rectum

Question 62

Definition of stage IVB uterine cancer?

Answer 62

Distant metastases

Question 63

Management of Stage I uterine cancer

Answer 63

Simple hysterectomy +/- lymphnodes

Question 64

5 year survival for stage I uterine cancer

Answer 64

80-90%

Question 65

Management of Stage II uterine cancer

Answer 65

Radical hysterectomy, LND, adjuvant RT therapy

Question 66

5 year survival for stage II uterine cancer

Answer 66

70 - 80%

Question 67

Management of Stage III uterine cancer

Answer 67

Total abdominal hysterectomy, LND, Cytoreduction, RT, Chemotherapy

Question 68

5 year survival for stage III uterine cancer

Answer 68

60%

Question 69

Management of Stage IV uterine cancer

Answer 69

IV Chemotherapy, hormone TX and RT

Question 70

5 year survival for stage IV uterine cancer

Answer 70

20%

Question 71

True or False: Risk of positive lymphnodes increase with the depth of invasion and grade of tumor

Answer 71

True

Question 72

What is the treatment strategy for a patient who has positive nodes at the time of surgery?

Answer 72

addition of chemotherapy or extended field radiation therapy

Question 73

What did the LAP2 trial show in terms of outcomes and survival between patients who underwent TLH vs. TAH

Answer 73

No difference in survival between TLH and TAH, fewer adverse events associated with TLH and better recovery with TLH

Question 74

In stage I disease, When should you add on radiation therapy?

Answer 74

positive LN, age > 70, Grade 2-3, outer 1/3 uterine invasion, LVSI

Question 75

What stage of uterine cancer requires addition of chemotherapy?

Answer 75

Stage III-IV

Question 76

What chemotherapy agents are generally used to treat uterine cancer?

Answer 76

Paclitaxel, Carboplatin

Question 77

What agent should be used in a MSI+/MSI high tumor?

Answer 77

Pembrolizumab

Question 78

What agent should be used in a Her2 positive tumor?

Answer 78

Trastuzumab

Question 79

How many weeks of Provera should be given for conservative hormonal therapy?

Answer 79

26 weeks

Question 80

What is the risk of ovarian recurrence in a patient who underwent hysterectomy without BSO for uterine cancer?

Answer 80

19%

Question 81

Follow up Surveillance for endometrial cancer

Answer 81

q 3 months for 2 years q 6 months for 3 years yearly after 5 years

Question 82

When does most endometrial cancer recurrence occur?

Answer 82

first 3 years

Question 83

What is the treatment or local recurrence in a patient without prior RT therapy?

Answer 83

RT therapy

Question 84

What is the treatment or local recurrence in a patient with prior RT therapy?

Answer 84

pelvic exenteration

Question 85

True or False: Estrogen therapy is safe to use for HRT in a patient with stage I or II disease

Answer 85

True

Question 86

Uterine sarcomas comprise what percentage of uterine cancer?

Answer 86

3-9%

Question 87

What are the three types of uterine sarcomas?

Answer 87

1. Leiomyosarcoma 2. Endometrial stromal sarcoma 3. Carcinosarcoma (MMMT)

Question 88

What is the most common type of uterine sarcoma?

Answer 88

Leiomyosarcoma

Question 89

What are the most common presenting symptoms in a patient with a leiomyosarcoma?

Answer 89

vaginal bleeding, pain

Question 90

True or False: Leiomyosarcomas always present with a rapidly enlarging fibroid?

Answer 90

False

Question 91

What are 2 risk factors for Leiomyosarcoma?

Answer 91

Long term tamoxifen use and previous pelvic RT therapy

Question 92

What is the common location for leiomyosarcoma?

Answer 92

usually intramural

Question 93

Endometrial Stromal Sarcoma typically affects what age group?

Answer 93

Younger patients

Question 94

What is the common location for endometrial stromal sarcoma?

Answer 94

Usually within endometrial cavity

Question 95

Definition of stage IA Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 95

Tumor < 5 cm

Question 96

Definition of stage IB Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 96

Tumor > 5 cm

Question 97

Definition of stage IIA Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 97

Tumor involves adnexa

Question 98

Definition of stage IIB Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 98

Tumor invades other pelvic structures

Question 99

Definition of stage IIIA Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 99

Tumor invades 1 abdominal site

Question 100

Definition of stage IIIB Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 100

Tumor invades more than 1 abdominal site

Question 101

Definition of stage IIIC Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 101

Tumor invades regional lymph nodes

Question 102

Definition of stage IVA Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 102

Tumor invades bladder or rectum

Question 103

Definition of stage IVB Leiomyosarcoma OR Endometrial Stromal Sarcoma

Answer 103

Distant Metastases

Question 104

What is the risk of sarcoma in a patient with a uterine fibroid?

Answer 104

0.5%