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OB/GYN Boards by Subject > Uterine cancer > Flashcards

Uterine cancer Flashcards

1
Q

What percent of new GYN cancers each year are endometrial?

A

50%

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2
Q

What percent of female cancers, including breast cancer, every year are endometrial?

A

15%

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3
Q

Risk factors for endometrial cancer

A

Nulliparity, infertility, anovulation, early menarche, late menopause, ERT (highest increased risk), Tamoxifen, obesity, granulosa cell tumors, other comorbidities (associated with obesity)

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4
Q

Genetic risk factor for endometrial cancer

A

Hereditary non-polyposis colon cancer (HNPCC) syndrome (Lynch)

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5
Q

Protective factors for endometrial cancer

A

Combination OCPs, pregnancy, cigarette smoking

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6
Q

How many people present with uterine bleeding as first sign of endometrial cancer?

A

85%

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7
Q

What other presenting signs are there for endometrial cancer? (3)

A
  1. Endometrial cells on postmenopausal pap
  2. Atypical endometrial cells on any pap
  3. Pyometrium in postmenopausal woman
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8
Q

Progression of hyperplasia to cancer (terminology)

A

Benign endometrial hyperplasia > endometrial intraepithelial neoplasia (EIN) > endometrioid adenocarcinoma

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9
Q

Most common histology of endometrial cancer

A

Endometrioid (90%)

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10
Q

What is different between EIN and cancer on histology?

A

Back-to-back glands

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11
Q

FIGO surgical stages for endometrial cancer

A

I - confined to uterus
II - cervical stroma extension
III - pelvic extension
IV - mucosa of bladder or bowel or distant disease

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12
Q

What proportion of patients are diagnosed with stage I endometrial cancer?

A

75%

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13
Q

Modes of treatment and their indications

A

Surgery - local disease
Radiation - spread in pelvis
Chemo - spread systemically outside uterus

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14
Q

Treatment for non-surgical candidate

A

Radiation alone (but survival is reduced)

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15
Q

Treatment for non-surgical candidate with grade 1 disease

A

Progestin therapy (Megace or LNG-IUD)

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16
Q

Most important prognostic factor for endometrial cancer

A

Lymph nodes (none 85%, pelvic LNs 65%, para-aortic LNs 45%)

17
Q

Other prognostic factors

A

Lymph node status, histologic type, depth of invasion, grade, peritoneal cytology (though no longer used for staging), ER/PR status, LVSI, age

18
Q

Survival type I vs type II

A

85% vs 50%

19
Q

Type I characterisitics

A

More common, median age 55, obese, PMB, estrogen-dependent, low-grade

20
Q

Type II characteristics

A

Less common, older patients, non-obese, not estrogen-dependent, serous or clear cell, high-grade, more likely metastatic

21
Q

Follow-up after treatment for endometrial cancer

A

Exam q3mos x2 yrs, then q6 mos till 5 yrs, then yearly

Imaging is not strictly recommended

22
Q

When do endometrial cancer recurrences occur?

A

80% occur in first 2 yrs

23
Q

Treatment for recurrence

A

Pelvic RT if none prior, add chemo if distant spread

24
Q

Chemo for endometrial cancer

A

Platinum, taxanes, doxorubicin

25
Q

Presentation of leiomyosarcoma (LMS)

A

Solitary solid mass with median size 10 cm, vaginal bleeding in 70% and pelvic pain 20%, cannot be sampled with EMBx

26
Q

Treatment for LMS

A

Hyst + BSO (though may preserve ovaries in younger women), relatively chemo and RT resistant

27
Q

Factors for prognosis of LMS

A

Extent of disease, size of tumor, mitotic activity (>10 per 10 hpf)
Spreads hematogeneously

28
Q

Presentation for endometrial stromal sarcoma (ESS)

A

Premenopausal, AUB, thickened endometrium, dx by endometrial sampling

29
Q

Treatment for ESS

A

Hyst + BSO, no surgical staging required, consider progestin therapy

30
Q

Expected outcome for ESS

A

Indolent tumor, good prognosis (unless high-grade, then poor)

31
Q

Presentation for carcinosarcoma (MMMT)

A

Combo of sarcomatous and epithelial cell, large and bulky mass, median age >65 y/o, PM and pelvic pain, sometimes pedunculated mass through cervix

32
Q

Treatment for carcinosarcoma

A

Hyst + BSO, consider surgical staging, consider chemo

33
Q

Prognosis for carcinosarcoma

A

Poor, spread is common

OB/GYN Boards by Subject (22 decks)

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