uterine cancer

Question 1

what is endometrial cancer

Answer 1

most common cancer of female ganital tract

peak age 60-70 (postmenopausal women)

two types
1) endometriod adenocarcinomas that originate from endometrial hyperplaseo

2)tumor of non endometroid origin

Question 2

cause of type 1 (endometroid adenocarcinomas)

Answer 2

long term estrogen exposure

RF
-NULLIPARITY

• early menarche and late menopause (increases estrogen exposure time)
• polycystic ovarian syndrome
• history of breast cancer]
• rx of breast cancer w/ tamoxifen
• lynch syndrome (hereditary nonpolyposis colorectal cancer)
• estrogen replacement therapy for menopause

Question 3

etio of type 2(non endometroid tumors)

Answer 3

ESTROGEN INDEPENDDANT GENETIC PREDIPOSISH

Question 4

factors with a protective effect against endometrial cancer

Answer 4

multiparity d/2 progesterone action in pregnancy

combined oral contraceptives (progesterone)

SMOKING? inhibs dysplasatic effect of estrogen

regular excercises increases androgen and reduces estrogen

soy diet ( contains progestin)

Question 5

what is endometrial hyperplasia

Answer 5

excessive proliferation in the presence of increased estrogen stimulation

predisposed endometial cancer type 1

histology shows
-hyperplasia w/ or w/o nuclear atypia

dg
US: endometrial thickening

premenopause:
above 1cm

postmenopause:
over 5 cm

Question 6

rx of endometrial hyperplasia

Answer 6

rx depends on age in relation to meno pause and the presence of atypia

pre meno
-w/o atypia: progestin therapy

w/ atypia: T

• TOTAL HYSTERECTOMY
• progestin therapy and close monitoring in women who wish to concieve

post meno
-w/o atypia: progestin therapy w/ follow up in 3-6 months

w/ atypia : hysterectomy w/ bilateral salpingoo[herectomy

Question 7

sx of endometrial cancer

Answer 7

abnormal uterine bleeding. amount reduces as menopause progresses

• pre: menometrorrhagia
• post: spotting / staining

palvic pain in later stages

Question 8

metastasis of endometrial cancer

Answer 8

local

• fallopian tube
• cervix
• vagina

lymhpgenic(late)
-pelvic & paraaorrtic LN

hematogenic
-lungs very rare in late stage

Question 9

complications of endometrial cancer

Answer 9

Pyometra

def: purulent endoometrial infection

d/2 obs of ervical os by tumor and 2ndary hematoma

Question 10

how is pyometra rx

Answer 10

dilation and drainage of cervical lumen

Question 11

what is the main sx of endometrial cancer

Answer 11

bleeding sx

Question 12

rx of Endometrial cancer

Answer 12

surgrical(post menopausal/ dont want kids)
-total hystterectomy(salpingoophorectomy)

medical(early stage)

• progestins
• radiotherapy

Question 13

prognosis of endometrial cancer

Answer 13

depends on stage at dg
localized 90%
metastasized 20%
type 2: poor