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Gynecologic Oncology > Endometrial Intraepithelial Neoplasia > Flashcards

Endometrial Intraepithelial Neoplasia Flashcards

1
Q

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

A

1%

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2
Q

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

A

3%

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3
Q

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

A

8%

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4
Q

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

A

29%

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5
Q

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

A

6 years

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6
Q

Endometrial Intraepithelial neoplasia (EIN) is also known as?

A

Atypical hyperplasia

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7
Q

Risk of coexisting cancer in a patient with EIN ?

A

40%

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8
Q

Risk of progression to endometrial cancer with EIN?

A

30%

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9
Q

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

A

Hysteroscopy and D&C

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10
Q

What percentage of the endometrium does an EMB sample?

A

15%

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11
Q

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

A

> 4mm

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12
Q

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

A

> 11mm

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13
Q

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

A

6%

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14
Q

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

A

40 - 200 mg/day

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15
Q

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

A

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

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16
Q

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

A

Mirena IUD

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17
Q

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

A

EMB q 3-6 months

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18
Q

Management of patient with regression of hyperplasia following hormonal therapy?

A

re-biopsy if repeat bleeding

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19
Q

Management of patient with persistence of hyperplasia following IUD placement?

A

add on oral progesterone

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20
Q

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

A

Hysterectomy

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21
Q

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

A

86%

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22
Q

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

A

26%

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23
Q

What is the most common GYN cancer in the US?

A

Endometrial

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24
Q

Greatest risk factor for type 1 endometrial cancer?

A

unopposed estrogen

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25
Q

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

A

increased up to 60%

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26
Q

What type of genetic mutation is associated with LYNCH syndrome?

A

Missmatch repair genes

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27
Q

What genes are involved with LYNCH syndrome?

A

MLH1, MSH2, PMS2, MSH6

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28
Q

What gene mutations are associated with Cowden disease?

A

PTEN mutations

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29
Q

BRCA1 increases the risk of which type of endometrial cancer?

A

Type 2

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30
Q

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

A

To evaluate for advanced/Metastatic disease

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31
Q

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

A

used in the pretreatment evaluation to determine myometrial invasion

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32
Q

Following which pap smear results should an EMB be preformed?

A
  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
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33
Q

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

A

Persistent abnormal bleeding with risk factors including obesity, anovulation

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34
Q

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

A

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

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35
Q

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

A

any spotting or vaginal bleeding with EMS > 4 mm

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36
Q

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

A

True

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37
Q

What type of uterine cancer is associated with type 1?

A

Endometriod

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38
Q

What mutation is associated with type 1 uterine cancer?

A

PTEN

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39
Q

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

A

False

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40
Q

What is the survival rate in type 1 uterine cancer?

A

85%

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41
Q

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

A

False

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42
Q

What type of uterine cancer is associated with type 2?

A

Clear cell, pap serous

43
Q

What mutation is associated with type 2 uterine cancer?

A

TP53, BRCA1

44
Q

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

45
Q

What is the survival rate in type 2 uterine cancer?

46
Q

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

47
Q

Serous uterine cancer accounts for what percentage of uterine cancer?

48
Q

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

49
Q

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

50
Q

Definition of grade 1 uterine cancer?

A

< 5% non morular/solid growth pattern

51
Q

Definition of grade 2 uterine cancer?

A

6 - 50% non morular/solid growth pattern

52
Q

Definition of grade 3 uterine cancer?

A

> 50% non morular/solid growth pattern

53
Q

Definition of stage IA uterine cancer?

A

< 50% myometrial invasion

54
Q

Definition of stage IB uterine cancer?

A

> 50% myometrial invasion

55
Q

Definition of stage II uterine cancer?

A

Tumor invades cervical stroma

56
Q

Definition of stage IIIA uterine cancer?

A

Tumor invades UP. Uterine serosa or adnexa

57
Q

Definition of stage IIIB uterine cancer?

A

Tumor invades DOWN. Vaginal or parametrial involvement

58
Q

Definition of stage IIIC uterine cancer?

A

Tumor invades NODES

59
Q

Definition of stage IIIC1 uterine cancer?

A

Tumor invades NODES. Pelvic nodes

60
Q

Definition of stage IIIC2 uterine cancer?

A

Tumor invades NODES. Para aortic

61
Q

Definition of stage IVA uterine cancer?

A

Tumor invades bladder or rectum

62
Q

Definition of stage IVB uterine cancer?

A

Distant metastases

63
Q

Management of Stage I uterine cancer

A

Simple hysterectomy +/- lymphnodes

64
Q

5 year survival for stage I uterine cancer

65
Q

Management of Stage II uterine cancer

A

Radical hysterectomy, LND, adjuvant RT therapy

66
Q

5 year survival for stage II uterine cancer

67
Q

Management of Stage III uterine cancer

A

Total abdominal hysterectomy, LND, Cytoreduction, RT, Chemotherapy

68
Q

5 year survival for stage III uterine cancer

69
Q

Management of Stage IV uterine cancer

A

IV Chemotherapy, hormone TX and RT

70
Q

5 year survival for stage IV uterine cancer

71
Q

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

72
Q

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

A

addition of chemotherapy or extended field radiation therapy

73
Q

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

A

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

74
Q

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

A

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

75
Q

What stage of uterine cancer requires addition of chemotherapy?

A

Stage III-IV

76
Q

What chemotherapy agents are generally used to treat uterine cancer?

A

Paclitaxel, Carboplatin

77
Q

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

A

Pembrolizumab

78
Q

What agent should be used in a Her2 positive tumor?

A

Trastuzumab

79
Q

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

80
Q

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

81
Q

Follow up Surveillance for endometrial cancer

A

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

82
Q

When does most endometrial cancer recurrence occur?

A

first 3 years

83
Q

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

A

RT therapy

84
Q

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

A

pelvic exenteration

85
Q

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

86
Q

Uterine sarcomas comprise what percentage of uterine cancer?

87
Q

What are the three types of uterine sarcomas?

A
  1. Leiomyosarcoma
  2. Endometrial stromal sarcoma
  3. Carcinosarcoma (MMMT)
88
Q

What is the most common type of uterine sarcoma?

A

Leiomyosarcoma

89
Q

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

A

vaginal bleeding, pain

90
Q

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

91
Q

What are 2 risk factors for Leiomyosarcoma?

A

Long term tamoxifen use and previous pelvic RT therapy

92
Q

What is the common location for leiomyosarcoma?

A

usually intramural

93
Q

Endometrial Stromal Sarcoma typically affects what age group?

A

Younger patients

94
Q

What is the common location for endometrial stromal sarcoma?

A

Usually within endometrial cavity

95
Q

Definition of stage IA Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor < 5 cm

96
Q

Definition of stage IB Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor > 5 cm

97
Q

Definition of stage IIA Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor involves adnexa

98
Q

Definition of stage IIB Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor invades other pelvic structures

99
Q

Definition of stage IIIA Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor invades 1 abdominal site

100
Q

Definition of stage IIIB Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor invades more than 1 abdominal site

101
Q

Definition of stage IIIC Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor invades regional lymph nodes

102
Q

Definition of stage IVA Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Tumor invades bladder or rectum

103
Q

Definition of stage IVB Leiomyosarcoma OR Endometrial Stromal Sarcoma

A

Distant Metastases

104
Q

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

Gynecologic Oncology (11 decks)

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