Uterine Flashcards
Uterine LMS and Endometrial Stromal Sarcoma Staging
What is the most important personal prognostic factor in endometrial cancer?
Race
What type of uterine sarcoma is most associated with prior RT?
Carcinosarcoma formerly known as Malignant mixed mullerian tumors (MMMT)
What chemo is least active in MMMT (carcinosarcoma)?
a) Carbo/taxol
b) Cis/Ifos
c) Ifos/Taxol
d) gemcitabine/docetaxel
d) Gemzar/taxotere
—> this is uterine sarcoma treatment! Not MMMT
What is the most commonly sporadically altered tumor-suppressor gene in type 2 endometrial CA?
p53
What is the most common sporadic oncogene amplified in type 2 endometrial CA?
HER2/neu
Which sporadic oncogenes are most commonly altered in type 1 endometrial cancer?
B-catenin, PIK3CA, KRAS (also FGFR2)
Which sporadic tumor suppressor gene is most commonly altered in type I endometrial cancer?
PTEN, followed by MLH1
Which hereditary tumor suppressor genes are most commonly altered in endometrial ca?
MLH1, MSH2, MSH6, PMS2
(All Lynch Syndrome genes here but EPCAM)
Describe the histology of endometrioid uterine carcinoma
Key feature is confluent or back to back glands lacking intervening stroma
Cribriform or microacinar configurations
Complex papillary, micropapillary or villoglandular structures
Resembles proliferative type endometrium with varying features / degrees of atypia but cytology must differ from that of surrounding nonneoplastic glands
Treatment for solitary endometrial stromal sarcoma (ESS) lung nodule?
A) surgery
B) letrozole
C) RT
D) chemo
surgery
Most likely to be assocaited with lymphatic spread?
A) Adenosarcoma
B) Carcinosarcoma (MMMT)
C) Leiomyosarcoma
D) Undifferentiated sarcoma
B) Carcinosarcoma (MMMT)
*pure sarcomas commonly metastasize hematogeneously
Chemotherapy for LMS
gemcitabine/docetaxel OR doxorubicin
doxorubicin/trabectedin
Chemotherapy for carcinosarcoma
carbo/taxol
OR
tax/ifos or cis/ifos
*carbo/taxol/dorstalimab (Stage III-IV tumors)
*carbo/taxol/trastuzamab (Stage III-IV her 2 positive carcinosarcoma)
(old Justin’s question noted that carbo/tax was not listed as an option)
GOG 108 - Ifos vs. Ifos/cisplatin shows no difference with more toxic regimen including cis
Best imaging to evaluate for myometrial invasion of uterine cancer
MRI