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Gyn Onc > Endometrial/ Uterus Tid bits > Flashcards

Endometrial/ Uterus Tid bits Flashcards

1
Q

What are the Mayo criteria for LN assessment?

A

Classify endoemtrial Ca patients at low risk. They have:
- endometriod endometrial adenocarcinoma
- Tumour diameter < 2cm
- Grade 1 or 2
- myometrial invasion (MI) < 50%

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2
Q

According to Vargas et al., of women with endometrial adenocarcinoma confined to the uterus what percentated were considered at high risk for nodal metastases according to the Mayo criteria?

A

78.9%

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3
Q

According to Vargas et al., of women with endometrial adenocarcinoma confined to the uterus considered high risk accorind to the Mayo criteria (78.9%), what percentage had nodal metastases?

A

6.4%

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4
Q

What are the three cytological criteria for LMS?

A

The Stanford criteria for the histologic diagnosis of malignant SMT (leiomyosarcoma) reported by Bell et al. include at least two of the following criteria:
- diffuse moderate-to severe atypia,
-a mitotic count of at least 10 mitotic figures (MF)/10 high power fields (HPFs) and
- tumor cell necrosis

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5
Q

What % of endometrial Ca is in premenopausal women?

A

10%

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6
Q

What % of EAC will have synchronous ovarian disease?

A

~5%

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7
Q

According to Cancer Australia what % of women with atypical endometrial hyperplasia will have cancer at time of hysterectomy?

A

~ 42%

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8
Q

Name 7 RF for Endometrial cancer:

A
  1. History of chronic anovulation
  2. Exposure to unopposed oestrogen
  3. PCOS
  4. Exposure to tamoxifen
  5. Strong FHx of endometrial and colon Ca ( Lynch Syndrome)
  6. Nulliparity
  7. Obesity (often with DM and HTN)
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9
Q

What is the risk of progression to endometrial endometriod adenocarcinoma from Atypical Hyperplasia / Endometriod Intraepithelial Neoplasia over 20 years of follow up?

A

28%

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10
Q

What is the risk of progression to endometrial endometriod adenocarcinoma from Hyperplasia without atypia over 20 years of follow up?

A

4.6 %

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11
Q

According to the american cancer society what is the risk of developing Endoemtrial cancer whilst on tamoxifen?

A

Less than 1% per year.

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12
Q

Which 2 genes are most commonly associated with Lynch syndrome?

A

MLH1 & MSH2

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13
Q

What 7 genes are asociated with lynch syndrome?

A

MLH1, MLH3, MSH 2, MSH 6, PMS 1 PMS2 and TGBR2

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14
Q

% of Serous Endometrial Ca that is HER2 +ve

A

40%

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15
Q

What % of Endometrial adenocarcinoma are due to Lynch syndrome

A

~ 3 %

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16
Q

What % of MMR deficient / MSI unstable tumours are due to a germline mutation.

A

~10% are due to a germline mutation in MLH1, PMS2, MSH2 and MSH6

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17
Q

What are 4 reasons to check for MMR status / MSI in EC?

A
  1. Diagnostic - MRI/MSI considered a marker for Endometrioid type Ca
  2. Pre-screening for women at a higher risk of Lynch
  3. Prognostics as per the Cancer Genome Atlas
  4. Predictive for a response to immune checkpoint inhibitors.
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18
Q

What is the cumulative incidence of EC by age 70 in women with MSH2 mutation?

A

51 %

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19
Q

What is the cumulative incidence of EC by age 70 in women with MSH 6 mutation?

A

49%

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20
Q

What is the cumulative incidence of EC by age 70 in women with MLH1 mutation?

A

34%

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21
Q

What is the cumulative incidence of EC by age 70 in women with PMS2 mutation?

A

24 %

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22
Q

Which has a better prognosis, Endometrial ca with POLEmut, p53abn or MMRd?

A

POLEmut - best
MMR - intermediate
p53abn - Poor

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23
Q

According to the 2020 ESGO guideline how may prognostic risk groups are there for endometrial Ca and what are they??

A

5 - Low, intermediate, High-intermediate, High, Advanced metastatic

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24
Q

According to the 2020 ESGO guideline when the molecular classification is UNKNOWN which cancers are included in the Low-risk prognostic group?

A

Stage IA endometriod + Low grade + LVSI -ve or focal

25
Q

According to the 2020 ESGO guideline when the molecular classification is UNKNOWN which cancers are included in the INTERMEDIATE prognostic group?

A

3 Groups:
- Stage IA EAC + high grade + LVSI -ve or focal
- Stage IA non-endometrioid (serous, clear cell, undiff , carcinosarc, mixed) with NO MM
- Stage IB EAC + Low grade + -ve of focal LVSI

26
Q

According to the 2020 ESGO guideline when the molecular classification is UNKNOWN which cancers are included in the HIGH - INTERMEDIATE risk prognostic group?

A

3 Groups:
- Stage I Endometrioid + substantial LVSI regardless of grade and depth of invasion
- Stage IB endometrioid high grade regardless of LVSI
- Stage II

27
Q

According to the 2020 ESGO guideline when the molecular classification is UNKNOWN which cancers are included in the HIGH-risk prognostic group?

A

2 groups
- Stage III-IV A with no residual disease
- Stage I-IVA non-endometiord with MMI and with no residual disease (serous, clear cell, undifferentiated, carcinosarcoma, mixed)

28
Q

According to the 2020 ESGO guideline when the molecular classification is UNKNOWN which cancers are included in the ADVANCED METASTATIC -risk prognostic group?

A

Stage III - IVA with residual disease
Stage IVB

29
Q

According to the 2020 ESGO guideline when the molecular classification is Known which cancers are included in the LOW-RISK prognostic group?

A

2 groups:
- Stage I - II POLEmut endometrial Ca with no residual disease
- Stage IA MMRd/ NSMP endometrioid Ca + Low grade + LFSI -ve or focal

30
Q

According to the 2020 ESGO guideline when the molecular classification is Known which cancers are included in the INTERMEDIATE-risk prognostic group?

A

3 Groups:

  • Stage IA MMRd/NSMP EAD + high grade + LVSI -ve or focal
  • Stage IA p53abn and/or non endometriod (serous clear cell, undiff, carcinomsarcoma, mixed) without MMI.
  • Stage IB - MMRd/NSMP EAC + Low grade + LVSI -ve or focal
31
Q

According to the 2020 ESGO guideline when the molecular classification is Known which cancers are included in the HIGH INTERMEDIATE-risk prognostic group?

A

3 Groups:

  • Stage I MMRd/NSMP EAC + substant LVSI regardless of grade or MMI
  • Stage IB - MMRd/NSMP EAC high grade regardless of LVSI
  • Stage II MMRd/NSMP EAC
32
Q

According to the 2020 ESGO guideline when the molecular classification is Known which cancers are included in the HIGH-risk prognostic group?

A

3 groups:
- Stage III-IVA MMRd/NSMP EAC with no residual disease
- Stage I-IVA p53abn EAC with MMI with no residual disease
- Stage I - IVA NSMP/MMRd - serous, undifferentiated carcinoma, carcinosarcoma with MMI and no residual disease

33
Q

According to the 2020 ESGO guideline when the molecular classification is Known which cancers are included in the ADVANCED METASTATIC-risk prognostic group?

A

2 groups
Stage III-IVA with the residual disease of any molecular type
Stage IVB of any molecular type

34
Q

What is the risk of occult omental metastases in women with endometrial carcinosarcoma?

A

~ 6%

35
Q

In which situation does the WHO 2020 suggest that an endometriod adenocarcinoma that has extended to the ovary be managed without additional treamtne as if they were 2 independent primaries?

A

If all the fol are fulfilled:
1. low grade EAC
2. NO more than superficial MMI
3. Absence of LVSI
4. No other mets.

36
Q

What is a Symplastic fibroid?

A

A Leiomyoma with giant cells, nuclear atypical and minimal mitotic activity ( 0 - 4 / 10 hpfs)
Also known as an atypical leiomyoma or Leiomyoma with bizarre nuclei
Not malignant but have the potential for the development of a LMS in them.

37
Q

What is the % rate of response of hormonal treatment in advanced / recurrent endometrial carcinoma

A

up to 55%
Low grade, slowly progressing, HR +ve tumours appear to gain the greatest benefit however clinical benefit has also bee observed in women with HR - ve tumour.

38
Q

The PARAGON trial utilised anastrozole in a cohort of 82 women with recurrent receptor +ve endometrial Ca. What was the response rate and what % of women had clinical benefit. (Gyn Onc 2019)

A

BestThe response rate of 7% and a clinical benefit rate of 44%

39
Q

WHat is the response rate to all forms of chemotherapy in recurrent endometrial cancer

A

~15%

40
Q

In GOG 33 what % of women with clinical stage I disease had ovarian metastases?

A

5%

41
Q

In the largest prospective trial of the risk of ovarian metastases from endometrial adenocarcinoma
1. Where did it come from and when
2. What was the likelihood of ovarian disease in clinically normal ovaries?
3. What were the RF for metastases
4. What is the likelihood of ovarian mets in the absence of any of the above RF?

A
  1. Lee et al., from South Korea in Gyn Onc 2007
  2. 7.3 % had ovarian disease (19 of 261)
  3. RF were > 45 y.o., non-endometrioid histology, intraoperative extrauterine disease, +ve LN
  4. WIth no RF above the 2 of 206 (0.97%)
42
Q

What proportion of all endometrial cancer are p53abn?

A

~15% of all. But account for 50-70% of deaths.

43
Q

What proportion of endometrial cancer deaths are due to p53abn tumours?

A

50 -70% of all endometrial cancer deaths are due to p53 abn tumours. they account for ~15% of all endometrial Ca.

44
Q

What proportion of grade 1/2 EAC will be 053abn

A

~ 5%

45
Q

What % of grade 3 EAC will be p53abn

A

~22%

46
Q

What % of serous endometrial cancer will be p53 mutants?

A

~92%

47
Q

What percentage of +ve LN will be smaller than 1cm in max diameter?

A

68 of 125 (54%) +ve LN were LESS than 10mm
O. Reich, R. Winter, H. Pickel, K. Tamussino, J. Haas, E. Petru 1996 - https://doi.org/10.1046/j.1525-1438.1996.06060445.xCitations:

48
Q

For LN > 1cm in size in EAC what % were +ve.

A

29% - (46 of 160) -ve LN in LN > 10mm in diameter
O. Reich, R. Winter, H. Pickel, K. Tamussino, J. Haas, E. Petru 1996 - https://doi.org/10.1046/j.1525-1438.1996.06060445.xCitations:

49
Q

When is an ovarian met in EAC treated as a synchronous primary?

A

Synchronous low grade Endometroid endometrial and Ov Ca.
- Pts with simultaneous involvement of the endometrium and ovary by low grade eAC had a favourable outcome. Suggesting synchronous primary rather than metastatic.
- For low-grade endometroid carcinomas, there is a clonal relationship between endometrial and ovarian carcinomas in the vast majority of cases. Indicating that the carcinoma arises in the endometrium and extends secondarily to the ovary.
○ WHO 2020 mentions that patients with
▪ “clonally related low grade endometroid carcinomas should be management without addition adjuvant treatment as if they were two independent primaries when fulfilling the following criteria”:
1. Low-grade Endometroid morphology
2. No more than superficial MMI
3. Absence of LVSI
4. No other metastases

50
Q

What is the probability of Endometrial cancer in a women with an ET of = 4mm.

A

<1%

51
Q

What is the ProMisE classifiction of endometrial Ca?

A

Proactive Molecular
Risk Classifier for Endometrial Cancer (ProMisE),

52
Q

What were the 4 mocular subtypes identified by TCGA for endometrial ca?

A

POLE mut
MSI hypermutated
Copy number low
Copy number high

53
Q

What are the 4 subtypes in ProMisE

A

POLEmut (POLE mut)
MMRd (MSI hypermutated)
NSMP (copy number low)
p53 mut (copy number high)

54
Q

The ESMO guidelines from 2022 divide EC into Low, intermediate, high-intermediate and high risk groups. There are 2 in the low risk group. They are? and Rx?

A

Stage IA Gr 1 &2 EC (dMMR and NSMP) and no or focal LVSI -
AND
Stage I/II POLEmut cancer ; for Stage III POLEmut cancers (says “POLEmut stage III might be considered low risk.. no data”)

For Surveillance.

55
Q

The ESMO guidelines from 2022 divide EC into Low, intermediate, high-intermediate and high-risk groups. There are 4 in the intermediate risk group. What are they and recommended Rx?

A

Stage IA Gr3 (dMMR and NSMP) and no or focal LVSI
Stage IA Non endometrioid and or p53 abn Ca without myometrial invasion and no or focal LVIS
Stage IB Gr1-2 (dMMR and NSMP) and no or focal LVSI
Stage II G1 EC (dmmR and NSMP) and no or focal LVSI

VBT is recommended for all except non infiltrative p53Abn with no myoinvasion. VBT can be omitted esp in women les than 60yo

56
Q

The ESMO guidelines from 2022 divide EC into Low, intermediate, high-intermediate and high-risk groups. The High-intermediate risk group contains 4 stages. Name and Rx?

A

Stage I Endometriod type (dMMR and NSMP) any grade and any depth of invasion with substantial LVSI
Stage IB Gr3 (dMMR and NSMP) regardless of LVSI
Stage II Gr1 (dMMR and NSMP) with substantial LVSI
Stage II Gr - G3 EC (dMMR and NSMP)

Regardless of nodal assessment EBRT is recommended and adding CT to RT could be considered, esp for G3 and or substantial LVSI.

57
Q

The ESMO guidelines from 2022 divide EC into Low, intermediate, high-intermediate and high-risk groups. The High risk group contains 3 descriptors. Name and Rx?

A

All stages and all histologies with p53-abn and myometral invasion
All stages with serous or undifferentiated carcinoma including carcinosarcoma with myometrial invasion
All stage III and IVA with no residual tumour, regardless of histology and molecular subtype

Rx options:
EBRT + concurrent CT
Sequential CT and RT
CT alone

58
Q

What are the PBS criteria for Lenvatinib and Pembrolizumab for endometrial cancer.

A

Advanced, metastatic or recurrent endometiral carcinoma.
Must have received prior Rx with platinum. No previous PD-1/PDL-1 inhibitor or TKI and WHO ECOG 0-1.
Must be in combination or have a contraindication to one

59
Q

Which Trial led to PBS approval of Pembro + Lenvatinib for EC and what did it say

A

Keynote 775 or Study 309. Open label RCT of Pembro + Lenvatinib in previously treated EC. Compared combo vs

Gyn Onc (23 decks)

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