EXAM #1: ENDOMETRIAL CANCER Flashcards
What is the most common invasive carcinoma of the female genital tract?
Endometrial carcinoma
What is endometrial carcinoma?
Malignant proliferation of endometrial glands
What are the risk factors for endometrial carcinoma?
All related to estrogen exposure:
1) Early menarche/late menopause
2) Nulliparity
3) Infertility with anovulatory cycles
4) Obesity
How does estrogen lead to endometrial carcinoma?
- Uncontrolled estrogen causes endometrial proliferation
- Prolonged stimulation may cause hyperplasia
What are protective factors for endometrial carcinoma?
1) Ovulation
2) Progestin therapy
3) Combination oral contraceptives
4) Menopause before 49
5) Normal weight
6) Multiparity
What is the most common type of endometrial/uterine carcinoma?
Adenocarcinoma
What are the two paths to endometrial carcinoma? Which is more common?
1) Hyperplasia*
2) Sporadic
*Most common
In a post-ovulatory/ secretory endometrium, how will the endometrial glands appear?
Saw-tooth
Histologically, how does endometrial hyperplasia appear?
Hyperplasia of the endometrial glands relative to the stroma
What is the most important predictor for progression of endometrial hyperplasia to carcinoma?
Cellular atypia
What combination of hyperplasia and atypia typically progresses to endometrial carcinoma?
Simple hyperplasia + cellular atypia
*Complex hyperplasia without atypia rarely progresses to carcinoma.
How does endometrial carcinoma present?
Postmenopausal bleeding
How does endometrial hyperplasia present?
Postmenopausal bleeding
What is an endometrial polyp?
Hyperplastic protrusion of the endometrium
What imaging study can be used to evaluate for an endometrial polyp?
Sonohystogeram
In treating a woman of reproductive age with abnormal uterine bleeding, you perform an endometrial biopsy. There is no cytologic atypia. Simple hyperplasia is seen. What do you do?
Intermittent progestin
In treating a woman of reproductive age with abnormal uterine bleeding, you perform an endometrial biopsy. There is no cytologic atypia. Complex hyperplasia is seen. What do you do?
Intermittent or cont. progestin
In treating a woman of reproductive age with abnormal uterine bleeding, you perform an endometrial biopsy. There is simple/mild cytologic atypia. What do you do?
- Intermittent progestin
- Biopsy again in 3-6 months
In treating a woman of reproductive age with abnormal uterine bleeding, you perform an endometrial biopsy. There is moderate to severe cytologic atypia. What do you do?
- Cont. progestin
- Biopsy again in 3-6 months
What is an abnormally thick endometrium in a post-menopausal woman?
Thickness greater than 4mm
If you suspect advanced stage endometrial cancer, what imaging should you get?
1) CT of the abdomen and pelvis
2) +/- chest CT
What is the gold standard surgical intervention for endometrial carcinoma?
TAHSBO
How does endometrial cancer spread?
1) Local extension
2) Lymphatic
3) Hematogenous (rarely)
Though the presenting symptom of endometrial carcinoma is post-menopausal bleeding, is this the most common cause of post-menopausal cancer?
NO
*DDx= endometrial hyperplasia and endometrial polyp
What should you do if abnormal endometrial cells around found on pap smear in an asymptomatic woman?
Endometrial biopsy
What are the most critical factors in determining the prognosis of endometrial carcinoma?
Tumor, grade, and histology
What is the second most critical factor in determining the prognosis for endometrial carcinoma?
Depth of invasion
What is a uterine sarcoma?
Neoplasm composed of the uterine myometrium/stroma
How does the prognosis for uterine sarcoma compare to adenocarcinoma?
Sarcoma has a poorer prognosis
Some ovarian cancers likely originate from what organ?
Fallopian tube
What is the primary risk factor for fallopian tube cancer?
BRCA1/2
*Also infertility and low parity
What type of cancer are most fallopian tube cancers?
Adenocarcinomas
What should you think if you see expulsion of clear or serosanguineous fluid from the vagina?
Fallopian tube cancer
*This is hydrops tubae profluens
What is Latzko’s Triad?
1) Hydrops tubae profluens
2) Colicky pain
3) Mass
