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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
preparation for XRT treatment
full bladder, empty rectum
26
CT scanning limits for endometrial cancer
sup= l3/l4 inf= 5cm inf of ischial tuberosities same scanning limits as for cervical cancer
27
conventional technique for treating endometrial cancer. when is this technique used?
conventional technique is used mostly in a palliative setting and is used as 4 field box. AP/PA and 2 laterals
28
conventional endometrial borders
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
most important prognostic factor:
stage
30
prognostic factors of endometrial cancer
``` stage (most important) Grade Depth of myometrial invasion L/n invasion LVI Age at diagnosis ```
31
what tumour marker is elevated in endometrialcancer?
ca-125 is elevated in 59% of patients with advanced or recurrent endometrial cancer
32
use of ultrasound in the diagnosis of endometrial cancer
determines the thickness of the myometrium
33
subtypes of the main pathology of endometrial cancer
adenocarcinoma endometrial cancer is the most common type: | its subdivided into: papillary, secretory, ciliated and adenocarcinoma with squamous differentiation
34
treatment operable stage 1 endometrial cancer
TAH BSO (total abdominal hysterectomy and bilateral sapling oophorectomy
35
risk groups on endometrial cancer
low risk, intermediate low risk, intermediate high risk and high risk
36
what falls under the low risk category
``` stage 1a (grades1-2) stage 1b (grade 1) ```
37
what falls under the intermediate now risk category
``` stage1a (grade3) stage 1B (grade2) stage 2a (grade1 and 2 <50% myometrial invasion) ```
38
what falls under the intermediate high risk category?
``` 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
what falls under the high risk category ?
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
treatment for low risk group
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
treatment for recurrent endometrial cancer with xrt delivered initially
EBRT of the whole pelvis to 45-50Gy / 25-30Fx
42
treatment for vaginal recurrences for endometrial cancers
incracavityary or interstitial bratty to bring the total dose to 80Gy
43
what patients get bratty alone
stage 1 A some IB, without myometrial invasion or LN mets can be treated with intracavitiary bratty alone
44
stage 1A grade 3 disease treatment | what is this considered to be risk wise
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
stage 1b GRADE 2 AND STGE 2A (,50% myometrial invasion) grades 1 and 2 treatment
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
treatment for patients with stage 1C (grade 3) | Treatment for patients with stage 2a (grade3 ), stage 2b
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
treatment for unfavourable histologies? | what are these unfavourable histologies?
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
treatment for advanced endometrial cancer (3 and 4)
pelvic EBRT, extended field XRT whole abdominal XRT and adjuvant chemo treated with cisplatin and doxorubicin
49
radioactive phosphorus in endometrial cancer
decreases recurrences in pts with subclinical intraperitoneal disease at 15mCI not to be combined with EBRT Bowel complications is the only adverse effect
50
palliation of endometrial cancer treatment
RT
51
coverage endometrial cancer sup inf and lats (nodal coverage)
sup to include common iliac inf to include upper half of vagina laterally 1.5-2cm beyond bony pelvis to include pelvic LN
52
acute side effects of XRT
fatigue, diahrrea, cystitis, desquamation of the vagina, anorexia and vomiting if periaortics are included
53
late side effects xrt
chronic cystitis, bowel obstruction, fistula
54
EBRT alone post op dose
45-50Gy
55
when is extended field XRT used
used for + paraaortic LN or +pelvic LN | 45Gy for microscopic disease +5 Gy boost
56
what diseases is endometrial ca associated with?
hypertension, type 2 diabetes, lynch syndrome
57
what tumour marker is suited? when?
Ca-125 should be studied for higher risk histologies (ex: papillary serous)
58
when is bratty lone used post-op
used for stage IC
59
what chemo agent could cause endometrial ca?
tamoxifen (Brca)

Skin Radiation therapy (40 decks)

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