Uterine cancer Flashcards
What percent of new GYN cancers each year are endometrial?
50%
What percent of female cancers, including breast cancer, every year are endometrial?
15%
Risk factors for endometrial cancer
Nulliparity, infertility, anovulation, early menarche, late menopause, ERT (highest increased risk), Tamoxifen, obesity, granulosa cell tumors, other comorbidities (associated with obesity)
Genetic risk factor for endometrial cancer
Hereditary non-polyposis colon cancer (HNPCC) syndrome (Lynch)
Protective factors for endometrial cancer
Combination OCPs, pregnancy, cigarette smoking
How many people present with uterine bleeding as first sign of endometrial cancer?
85%
What other presenting signs are there for endometrial cancer? (3)
- Endometrial cells on postmenopausal pap
- Atypical endometrial cells on any pap
- Pyometrium in postmenopausal woman
Progression of hyperplasia to cancer (terminology)
Benign endometrial hyperplasia > endometrial intraepithelial neoplasia (EIN) > endometrioid adenocarcinoma
Most common histology of endometrial cancer
Endometrioid (90%)
What is different between EIN and cancer on histology?
Back-to-back glands
FIGO surgical stages for endometrial cancer
I - confined to uterus
II - cervical stroma extension
III - pelvic extension
IV - mucosa of bladder or bowel or distant disease
What proportion of patients are diagnosed with stage I endometrial cancer?
75%
Modes of treatment and their indications
Surgery - local disease
Radiation - spread in pelvis
Chemo - spread systemically outside uterus
Treatment for non-surgical candidate
Radiation alone (but survival is reduced)
Treatment for non-surgical candidate with grade 1 disease
Progestin therapy (Megace or LNG-IUD)
Most important prognostic factor for endometrial cancer
Lymph nodes (none 85%, pelvic LNs 65%, para-aortic LNs 45%)
Other prognostic factors
Lymph node status, histologic type, depth of invasion, grade, peritoneal cytology (though no longer used for staging), ER/PR status, LVSI, age
Survival type I vs type II
85% vs 50%
Type I characterisitics
More common, median age 55, obese, PMB, estrogen-dependent, low-grade
Type II characteristics
Less common, older patients, non-obese, not estrogen-dependent, serous or clear cell, high-grade, more likely metastatic
Follow-up after treatment for endometrial cancer
Exam q3mos x2 yrs, then q6 mos till 5 yrs, then yearly
Imaging is not strictly recommended
When do endometrial cancer recurrences occur?
80% occur in first 2 yrs
Treatment for recurrence
Pelvic RT if none prior, add chemo if distant spread
Chemo for endometrial cancer
Platinum, taxanes, doxorubicin
Presentation of leiomyosarcoma (LMS)
Solitary solid mass with median size 10 cm, vaginal bleeding in 70% and pelvic pain 20%, cannot be sampled with EMBx
Treatment for LMS
Hyst + BSO (though may preserve ovaries in younger women), relatively chemo and RT resistant
Factors for prognosis of LMS
Extent of disease, size of tumor, mitotic activity (>10 per 10 hpf)
Spreads hematogeneously
Presentation for endometrial stromal sarcoma (ESS)
Premenopausal, AUB, thickened endometrium, dx by endometrial sampling
Treatment for ESS
Hyst + BSO, no surgical staging required, consider progestin therapy
Expected outcome for ESS
Indolent tumor, good prognosis (unless high-grade, then poor)
Presentation for carcinosarcoma (MMMT)
Combo of sarcomatous and epithelial cell, large and bulky mass, median age >65 y/o, PM and pelvic pain, sometimes pedunculated mass through cervix
Treatment for carcinosarcoma
Hyst + BSO, consider surgical staging, consider chemo
Prognosis for carcinosarcoma
Poor, spread is common
