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Skin Radiation therapy > ENDOMETRIUM > Flashcards

ENDOMETRIUM Flashcards

1
Q

endometrium is the ____ most common gyne cancer

A

most common and 4th most common malignancy in women

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2
Q

age at diagnosis is usually ____.

A

61 y.o.usually in postmenopausal women

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3
Q

what races is endometrial cancer common in

A

endometrial cancer is common in women who are white over black women but the severity is worse in black women and it is not common in asian women

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4
Q

risk factors for developing endometrial cancer

A 
Estrogen replacement therapy
Obesity
Early menarche 
Late menopause
Tamoxifen (tx for 5+ years increases risk)
Polycystic ovarian syndrome
Endometrial hyperplasia
Previous XRT
Diabetes
Estrogen secreting ovarian tumours
Lynch syndrome
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5
Q

layers of the uterus

A

Serosa (parietal muscle- most exterior)
Myometrium (Smooth muscle- middle)
Endometrium (mucous membrane- most interior)

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6
Q

functions of the endometrium, what is it?

A

endometrium is the lining of the uterus, it thickens during menstruation to prepare for a baby

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7
Q

areas of distant mets with an endometrium primary

A

Distant mets to lungs and bone

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8
Q

most common presentation for endometrium cancer

A

postmenopausal bleeding, postmenopausal bleeding indicates cancer in 1/3 of cases

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9
Q

most endometrial cancers are diagnosed in what stage?

A

80% are diagnosed in stage 1

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10
Q

what are late signs & symptoms of endometrial cancer

A 
Hematuria
Hematochezia
Constipation
Lower extremity edema
Pain
Abdominal distention
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11
Q

detection and diagnosis of endometrial cancer

A

most are detected through postmenopausal bleeding that can lead to anemia.
Endometrial Biopsy: 90% effective in the detection of cancer- removes small pieces of the endometrium
Dilation & Curettage (D&C): The procedure in which the cervix is widened so that a curette can be inserted to remove cells

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12
Q

most common pathology of endometrial cancer

A

80% are adenocarcinoma

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13
Q

What staging systems are used in endometrial cancer

A

FIGO and TNM

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14
Q

staging of endometrial cancer

A 
Stage I:
A) Confined to the endometrium- no myometrial invasion
B) Invasion <50% of myometrium
C) Invasion >50% of myometrium
Stage II: Invasion of the cervix
Stage III: Spread to pelvic tissue
Stage IV: 
A) Spread to bladder or rectum
B) Distant mets
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15
Q

when is surgery used in the treatment of endometrial cancer

A

in stages 1 and 2

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16
Q

most common procedures used in endometrial cancers

A

Total abdominal hysterectomy and bilateral salpingo-oophorectomy are used the most (TAH BSO)

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17
Q

whats a unilateral or bilateral saplingo oophorectomy

A

unilateral saplingo oophorectomy- is removal of one tube and ovary
bilateral sapling oophorectomy- is the removal of both tubes and both ovaries

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18
Q

what is an Omenectomy?

A

Removal of part or all of the abdominal lining

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19
Q

indications systemic therapy in endometrial cancer

A

not commonly used except for in late stage high risk cases

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20
Q

what chemotherapeutic agents are used in endometrial cancer?

A

cisplatin or carboplatin and taxotere

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21
Q

indications for the use of progesterone in endometrial cancer

A

used for palliation of metastatic disease

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22
Q

agents used for the palliation of endometrial cancer?

A

adriamyacin and progesterone

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23
Q

indications for XRT in endometrial cancer

A

Adjuvant following sx for high risk early stage, in combo w/ brachy
Primary treatment for late stage
Palliation

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24
Q

treatment set-up in endometrial cancer

A

FDLI, supine, hands on chest holding ring and large square under head, can be treated prone to remove the bowel and the bladder from the treatment field more but this occurs rarely

25
Q

preparation for XRT treatment

A

full bladder, empty rectum

26
Q

CT scanning limits for endometrial cancer

A

sup= l3/l4
inf= 5cm inf of ischial tuberosities
same scanning limits as for cervical cancer

27
Q

conventional technique for treating endometrial cancer. when is this technique used?

A

conventional technique is used mostly in a palliative setting and is used as 4 field box. AP/PA and 2 laterals

28
Q

conventional endometrial borders

A

Sup= L5/S1 or L4/L5 (may be increased to T11/12 if paraortics are involved)
Inf= Cover the upper ½ of the vagina
Lat= 2cm lat of pelvic brim
Ant= Symphysis pubis
Post= S2/S3 or 2-3cm post to known extent of disease or to cover 50% of the rectum
If the paraortics are involved then there may need to be extended field or the pelvis and the paraortics may have to be treated separately (requiring a gap calc)

29
Q

most important prognostic factor:

A

stage

30
Q

prognostic factors of endometrial cancer

A 
stage (most important)
Grade
Depth of myometrial invasion
L/n invasion
LVI
Age at diagnosis
31
Q

what tumour marker is elevated in endometrialcancer?

A

ca-125 is elevated in 59% of patients with advanced or recurrent endometrial cancer

32
Q

use of ultrasound in the diagnosis of endometrial cancer

A

determines the thickness of the myometrium

33
Q

subtypes of the main pathology of endometrial cancer

A

adenocarcinoma endometrial cancer is the most common type:

its subdivided into: papillary, secretory, ciliated and adenocarcinoma with squamous differentiation

34
Q

treatment operable stage 1 endometrial cancer

A

TAH BSO (total abdominal hysterectomy and bilateral sapling oophorectomy

35
Q

risk groups on endometrial cancer

A

low risk, intermediate low risk, intermediate high risk and high risk

36
Q

what falls under the low risk category

A 
stage 1a (grades1-2) 
stage 1b (grade 1)
37
Q

what falls under the intermediate now risk category

A 
stage1a (grade3) 
stage 1B (grade2)
 stage 2a (grade1 and 2 <50% myometrial invasion)
38
Q

what falls under the intermediate high risk category?

A 
stage 1B (grade 3)
stage 2a (grade3) <50% myometrial invasion
stage 1c (grade 1 and 2) 
stage 2a  (grade 1 and 2) >50% myometrial invasion and lymphovascular invasion
39
Q

what falls under the high risk category ?

A

stage 1C (grade 3)
stage 2 a (grade 3) <50% myometrial invasion
stage 2b any grade
or any clear cell carcinoma, or uterine papillary serous carcinoma and stages 3 and 4

40
Q

treatment for low risk group

A

low group ( stage 1A (grades 1-2) stage IB (grade 1) with no evidence of lymphovascular invasion no further treatment is used if LVI (+) Intravaginal brachytherapy can be used

41
Q

treatment for recurrent endometrial cancer with xrt delivered initially

A

EBRT of the whole pelvis to 45-50Gy / 25-30Fx

42
Q

treatment for vaginal recurrences for endometrial cancers

A

incracavityary or interstitial bratty to bring the total dose to 80Gy

43
Q

what patients get bratty alone

A

stage 1 A some IB, without myometrial invasion or LN mets can be treated with intracavitiary bratty alone

44
Q

stage 1A grade 3 disease treatment

what is this considered to be risk wise

A

risk wise, it is intermediate low risk group
treatment is adjuvant brachy if there is extensive surgical staging
Pelvic EBRT is given if there is no surgical staging with + lymphovascular invasion or age >60 y.o.

45
Q

stage 1b GRADE 2 AND STGE 2A (,50% myometrial invasion) grades 1 and 2 treatment

A

considered to be intermediate low risk.
if there is extensive surgical staging the patient may be offered brachy over monitoring
patients >60y.o. with Lymphovascualr invasion should get EBRT
EBRT is recommended for patients >60y.o.
IVB should be given to patients <60y,o, with Lymphovascualr invasion

46
Q

treatment for patients with stage 1C (grade 3)

Treatment for patients with stage 2a (grade3 ), stage 2b

A

IC (grade 3) should be given should get EBRT with or without brachy boost
stage 2B and stage 2A (grade 3) SHOULD GET EBRT+brachy

47
Q

treatment for unfavourable histologies?

what are these unfavourable histologies?

A

Unfavourable e histologies: papillary serous and clear cell

They are at a higher risk for recurrence and require adjuvant CX as well as EBRT +Brachy

48
Q

treatment for advanced endometrial cancer (3 and 4)

A

pelvic EBRT, extended field XRT whole abdominal XRT and adjuvant chemo treated with cisplatin and doxorubicin

49
Q

radioactive phosphorus in endometrial cancer

A

decreases recurrences in pts with subclinical intraperitoneal disease at 15mCI
not to be combined with EBRT
Bowel complications is the only adverse effect

50
Q

palliation of endometrial cancer treatment

A

RT

51
Q

coverage endometrial cancer sup inf and lats (nodal coverage)

A

sup to include common iliac
inf to include upper half of vagina
laterally 1.5-2cm beyond bony pelvis to include pelvic LN

52
Q

acute side effects of XRT

A

fatigue, diahrrea, cystitis, desquamation of the vagina, anorexia and vomiting if periaortics are included

53
Q

late side effects xrt

A

chronic cystitis, bowel obstruction, fistula

54
Q

EBRT alone post op dose

A

45-50Gy

55
Q

when is extended field XRT used

A

used for + paraaortic LN or +pelvic LN

45Gy for microscopic disease +5 Gy boost

56
Q

what diseases is endometrial ca associated with?

A

hypertension, type 2 diabetes, lynch syndrome

57
Q

what tumour marker is suited? when?

A

Ca-125 should be studied for higher risk histologies (ex: papillary serous)

58
Q

when is bratty lone used post-op

A

used for stage IC

59
Q

what chemo agent could cause endometrial ca?

A

tamoxifen (Brca)

Skin Radiation therapy (40 decks)

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