Uterus/Endometrium Flashcards
Where is the uterus located?
The uterus is located in the pelvis between the bladder and rectum.
What are the three parts of the uterus?
The uterus is divided into three parts: the body, cervix, and fundus.
What are the three layers of the uterine cavity?
The uterine cavity is made up of three layers:
• Mucous membrane lining (endometrium)
• Smooth muscle layer (myometrium)
• Outer serous coat (perimetrium)
Where do endometrial cancers originate?
Endometrial cancers originate from the endometrium layer of the uterus.
What is the most common malignancy of the female genital tract?
Endometrial cancer.
In which demographic is endometrial cancer most prevalent?
Postmenopausal women (55+).
Which group has higher incidence rates of endometrial cancers?
Caucasian women, but African American women have a higher mortality rate.
What type of cancers are endometrial cancers related to?
Hormone-related cancers.
What is the major risk factor for endometrial cancers?
High cumulative exposure to estrogen.
How much higher is the risk of developing endometrial cancer in obese women?
Threefold to fivefold higher.
What are some other risk factors for endometrial cancer?
Estrogen replacement without progesterone, nulliparity, late menopause, early menarche, irregular menstruation, diabetes, history of infertility.
What is the risk associated with women taking tamoxifen?
Higher risk for endometrial cancers.
What hereditary condition increases the risk of endometrial cancer?
Hereditary colon cancer.
What is the most common type of endometrial cancer?
Adenocarcinomas (70%)
How do adenocarcinomas in endometrial cancer develop?
They evolve from endometrial hyperplasia or de novo.
What are the types of tumors associated with endometrial cancer?
Sarcomas
Name a type of endometrial sarcoma.
Endometrial stromal sarcoma
What is another type of sarcoma related to endometrial cancer?
Mixed mesodermal
What is a benign tumor associated with endometrial cancer?
Benign leiomyoma (fibroids)
Is there a standard screening for endometrial cancer?
No standard screening for endometrial cancer.
What are common symptoms of endometrial cancer?
Symptoms may include postmenopausal bleeding.
At what stage are most endometrial cancers diagnosed?
Most endometrial cancers are diagnosed in stage 1.
What is the diagnosis procedure for endometrial cancer?
Dilatation and curettage (D&C).
What are the routes of spread for endometrial cancer?
Direct Extension, Lymphatic
What structures can endometrial cancer directly extend to?
Myometrial wall, Cervix, Ovaries, Vagina, perimetrium, Bladder, Rectum
Which lymph nodes are involved in the lymphatic spread of endometrial cancer?
External iliac nodes, Internal iliac nodes, Common iliac nodes
What staging system is used for endometrial cancer?
International Federation of Gynecology and Obstetrics Staging System (FIGO)
Also includes American Joint Committee on Cancer TNM staging system.
What are the treatment options for endometrial cancer?
Surgery, Endocrine/Hormone Therapy, Chemotherapy, Intracavitary Radiation Therapy (Brachytherapy), External Beam Radiation Therapy, Immunotherapy.
What factors determine the treatment approach for endometrial cancer?
The stage, grade, and medical condition of the patient.
What is the treatment approach for early-stage endometrial cancer?
Surgery alone or in combination with adjuvant therapies can yield definitive results.
What is a bilateral salpingo-oophorectomy?
Surgical removal of the fallopian tubes and the ovaries.
What is the main hormone treatment for endometrial cancer?
The main hormone treatment for endometrial cancer uses progesterone.
What are progestins used for in the context of endometrial cancer?
Progestins are a type of hormone treatment used for endometrial cancer.
What is the role of chemotherapy in locally recurrent cancer?
Chemotherapy is used as a radiation sensitizer in locally recurrent cancer.
What is the majority of recurrences in endometrial cancer associated with?
The majority of recurrences are distant metastasis to lung or bone with associated pelvic recurrence in 50%.
What are the two types of brachytherapy used for endometrial cancer?
LDR brachytherapy and HDR brachytherapy.
What is LDR brachytherapy?
The applicator with the radiation source is left in for about 1 to 4 days. The patient usually needs to stay in the hospital during treatment.
What isotopes are used in intracavitary radiation?
Iridium-192 and Cesium-137.
What is the function of the tandem applicator?
The tandem applicator holds sources within the uterine canal.
What are ovoids or colpostats used for?
They hold sources within the vaginal fornixes.
What areas are targeted in intracavitary radiation?
Uterus, cervix, and vagina.
What techniques are used for implantation if the uterus is present?
Heyman capsule techniques or an intrauterine tandem are used for implantation.
What devices are used for postoperative treatment in HDR for endometrial cancer?
A domed cylinder or vaginal Colpostats are used if brachytherapy is necessary.
What is the half-life of Iridium 192 used in brachytherapy?
74 days
What are typical LDR brachytherapy doses for endometrial cancer?
60-Gy to 70-Gy surface dose in two treatment sessions
What are typical high-dose-rate brachytherapy dose fractions?
7 Gray to a 0.5-cm depth prescribed for three treatment sessions to a total of 21 Gy
What is the energy range used for EBRT in endometrial cancer?
Energy - 10-18MV
What are the techniques used in EBRT for endometrial cancer?
Techniques include:
- Four field box
- IMRT
- VMAT
What is the typical EBRT dose for endometrial cancer?
Typical EBRT dose is 45-50Gy with approximately 1.8Gy per fraction.
What is the maximum dose for the endometrial cavity with combined therapy?
The endometrial cavity can be taken to 75 to 90 Gray with combined external beam therapy and low-dose-rate brachytherapy.
What are the acute side effects of radiation treatment for endometrial cancer?
Fatigue, Diarrhea, Cystitis, Nausea, Anorexia, Vaginal dryness
More common after vaginal brachytherapy than after pelvic radiation.
What are the chronic side effects of radiation treatment for endometrial cancer?
Chronic cystitis, Proctosigmoiditis, Small bowel enteritis, Obstruction, Vaginal stenosis
Caused by scar tissue, which can cause the vagina to become shorter and more narrow.
