Endometrium Flashcards
Choose all correct answers:
a) transvaginal ultrasound for endometrial thickness is a useful screening test for endometrial hyperplasia and malignancy
b) endometrial biopsy is a useful screening test in postmenopausal women
c) An asymptomatic postmenopausal woman with an incidental finding of 8mm endometrial thickness should receive an endometrial biopsy as part of her work-up
d) yearly transvaginal ultrasound for endometrial thickness is indicated for women on tamoxifen
a) false
b) false -not screening -only symptomatic
c) false -no biopsy if no bleeding
d) false
Choose all correct answers regarding endometrial cancers:
a) 70% are stage 1 at diagnosis
b) 50-75% present with bleeding
c) for a woman presenting with PMB, the a priori risk of endometrial cancer is about 10%, 1% if on HRT
d) for women with Lynch syndrome, the incidence of endometrial cancer by age 70 is 20-60%
a) true
b) false 90%
c) true
d) true
List risk factors for endometrial cancer:
obesity, nulliparity, early menarche/late menopause, an ovulation (PCOS), tamoxifen, white race (though black women have increased mortality)
The reason endometrial thickness is not a good screening test for endometrial cancer is that:
a) the test is not sensitive
b) the test is not specific
c) endometrial cancer has a low population incidence
d) the cost is too high
b
Choose all correct answers:
a) current use of HRT is associated with increased endometrial thickness on ultrasound
b) women with bleeding on HRT should undergo hysteroscopy D and C only if endometrial thickening is > 10mm
c) in postmenopausal women, the chance of malignancy in a polyp is between 0.5 and 5%
d) tamoxifen is contraindicated in women with endometrial hyperplasia
e) the false negative rate of an endometrial bx is 5-15%
a) true
b) false -if >8mm
c) true
d) controversial but true as per ACOG
e) true
Which patients are candidates for surgical management of endometrial cancer without a lymph node dissection in a non-cancer centre?
Low risk disease = Figo grade 1 endometrial adenocarcinoma
F2-3 and all other histologies are high risk
Choose all correct answers regarding endometrial cancer:
a) pelvic lymphadenectomy confers a survival benefit
b) risk of pelvic lymph node involvement for Figo 1 is less than 1%
c) the discordance between pre-op and hysterectomy grading of endometrial cancer approaches 30%
d) MRI is the most sensitive imaging modality to estimate depth of invasion pre-op
a) false -directs adjuvant treatment
b) false 2.8%
c) true 15-30%
d) true
Choose all correct answers regarding endometrial cancer:
a) for patients with intermediate risk disease, external beam radiation is superior to vault brachytherapy in terms of recurrence risk
b) patients undergoing expectant management for intermediate risk disease have higher reported QOL than those receiving radiotherapy
c) the most common site of endometrial cancer recurrence is the vaginal vault
d) adjuvant chemotherapy is indicated for patients with low-risk disease
a) false equal
b) true
c) true
d) false
List 5 prognostic indicators for patients with endometrial cancer.
stage, grade, tumour type, lymphovascular space involvement, depth of invasion, age
Define low risk endometrial cancer:
What adjuvant treatment is recommended if any?
Stage 1A, Figo 1/2, endometriod type,
no further tx needed, recurrence risk 2-10%
Define intermediate risk endometrial cancer:
What adjuvant treatment is recommended if any?
Stage 1B, grade 1/2 endometriod OR grade 3 + LVSI, >60 years of age, recurrence risk 20-25%,
pelvic radiation or brachytherapy
Define high risk endometrial cancer. What adjuvant treatment is recommended if any?
Stage II-IV OR non endometriod (serous or clear cell)
recurrence risk is 30-65%
Chemorads
What follow-up would you recommend for a low risk endometrial cancer patient following surgery?
Counsel on signs/sx recurrence. F/U with pelvi-rectal exam q 6/12 for 2 years then annually for another 2 years
What follow-up would you recommend for a high risk endometrial cancer patient following surgery/adjuvant tx?
Counsel on signs/sx recurrence. F/u with pelvi-rectal exam q 3/12 x 3 years then q 6/12 x 2 years, then annual screening for life
What questions will you ask on history of a woman with PMB to assess for endometrial cancer risk factors?
hx anovulation, early menarche/late menopause, lack of parity, obesity, PCOS, long term unopposed estrogen therapy, tamoxifen use, family hx endometrial/ovarian Ca (Lynch)
A patient has a negative endometrial biopsy but persistent post-menopausal bleeding and thickened endometrium of 10mm on ultrasound. What is the next step in management?
a) repeat biopsy
b) expectant mgmt with repeat u/s
c) reassurance
d) hysteroscopy and sampling
e) hysterectomy
d
A patient with endometrial cancer invading the cervix. What is the stage?
a) 1B
b) 2
c) 3A
d) 3B
b
A patient with endometrial cancer and positive pelvic but not para-aortic nodes. What is the stage?
a) 2
b) 3A
c) 3B
d) 4A
b
What proportion of patients with endometrial cancer are pre-menopausal?
10-15% perimenopausal (2-3% under age 40)
What is the endometrial cancer screening recommendation for a patient with Lynch syndrome?
Yearly endometrial sampling starting age 30
Choose all correct answers regarding endometrial cancer:
a) 10% are hereditary
b) For pt with PMB after age 70, pre-test probability of cancer is 50%
c) tamoxifen increases the lifetime risk of endometrial cancer by 6-8X
d) soy protein (isoflavones) have been shown to decrease the lifetime risk of endometrial cancer in observational studies
all true
Of women with atypical endometrial hyperplasia on biopsy, what percentage will have endometrial cancer on hysterectomy pathology?
35-40% (15% have high risk features requiring staging)
Of women having hysterectomy for endometrial cancer, what percentage will be upgraded?
30%
What is the next mgmt step for a patient with PMB, insufficient tissue on endo bx and thickened EMT on u/s?
a) reassurance
b) re-biopsy
c) repeat u/s in 6/12
d) hysteroscopy D and C
d
