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REPRO > Endometrial cancer > Flashcards

Endometrial cancer Flashcards

1
Q

Endometrial cancer incidence

A

4th most common cancer in females
most common gynecological cancer
5 year survival ~70%

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2
Q

Oncogenesis of endometrial cancer

A

unopposed estrogen leading to hyperplasia, then ca

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3
Q

Natural history of endometrial cancer

A

extension through uterus

spread into lymph nodes and blood

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4
Q

Risk factors of endometrial cancer

A 
unopposed estrogen (exogenous hormones, obesity, anovulation)
obesity: 3-10x
Lynch syndrome (lifetime risk 40-60%)
HTN
diabetes: 2-3x
irregular menstruation
nulliparity
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5
Q

Prevention of endometrial cancer

A

decrease BMI

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6
Q

Pre-cancerous stage of endometrial cancer

A

endometrial hyperplasia

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7
Q

Spread of endometrial cancer

A

Local: uterus, cervix, colon, bladder
Lymph: para-aortic nodes or pelvic nodes
Blood: uncommon, metastasis to lungs, liver, bone

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8
Q

SSx of endometrial cancer

A

Postmenopausal bleeding

abnormal vaginal bleeding

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9
Q

Diagnosis of endometrial cancer

A

biopsy
D&C if biopsy not enough
US can give suspicion but not diagnosis

Use IHC for all endometrial ca to screen for Lynch syndrome

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10
Q

Staging of endometrial cancer

A

surgical
I: confined to uterus (majority of patients present here)
II: cervix
III: adnexae
IV: bowel, bladder, distant metastasis (rare)

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11
Q

Tx of endometrial cancer

A

1) Surgery!
Hysterectomy + bilateral salpingo-oophorectomy +/- lymmphadenectomy

Adjuvant:
depending on stage and risk of recurrence
Pelvic radiation - local
Chemo - distant
Hormone therapy - advanced stage, well-differnetiated (grade 1)

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12
Q

Followup of endometrial cancer

A

For recurrence:

  • Pelvic exam q6/12 for 2-3 y, then annually
  • Screening tests are NOT USEFUL
  • most are symptomatic (vaginal bleeding)
  • majority recur in pelvis

To maximize survivorship:

  • reduces risk of other cancers
  • QOL
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13
Q

Type I endometrial ca

A

“low risk”
more common
Age ~62 (20%

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14
Q

Type I endometrial ca risk factors

A

Estrogen-related (E>P)
obesity: conversion of androstenediol –> estrogen
PCOS
T2DM: hyperinsulinemia
Tamoxifen: selective estrogen receptor modulator - used to treat breast ca, but increases endometrial hyperplasia

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15
Q

Type II endometrial ca

A

high risk
rare
age ~70
almost always postmenopausal
NOT estrogen related, more likely to have normal BMI
non-endometriod: serous, clear cell, malignant mixed mullerian tumour (carcinosarcoma)
All high grade (grade 3)

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16
Q

Prognostic factors in endometrial cancer

A

Grade
Depth of myometrial invasion
Cervical stroma involvement

17
Q

other cancer risks after endometrial cancer

A

breast: 2x higher, estrogen, 1-2% in 5 y

Colorectal: 3-7x, obesity, radiotherapy, Lynch syndrome; 1-2% in 5 year

18
Q

Lynch syndrome

A

hereditary non-polyposis colorectal cancer (HNPCC)
inherited mutation in DNA mismatch repair MMR gene
High lifetime risks of cancer
- Colorectal 60%
- endometrial 60%
- ovarian 10%
- gastric 10%

19
Q

Screening to reduce cancer risk in Lynch syndrome

A

CRC: biannual colonoscopy from 25 y, then annual from 40
Endometrial/ovarian:
- annual endometrial biopsy and US from age 25-35 (not proven to be effective)
- prophylactic surgery

20
Q

How to counsel on prophylactic surgery for ca

A

Early (age 30) vs later (early 40s)
hormone replacement therapy afterwards

Progestins as alternative to surgery for young women

  • grade 1 endometriod tumours, no myometrial invasion
  • adverse effects
  • response rate 60-70%; need regular surveillance
  • keep fertility!
21
Q

Amsterdam II criteria

A 
3-2-1 rule
3 family members
2 generations
1 under age 50
but family history not enough
22
Q

Lynch syndrome Dx

A

Amsterdam II criteria

Immunohistochemistry to detect 4 MMR proteins

23
Q

IHC algorithm for endometrial ca

A

Test all endometrial ca patients for 4 MMR proteins
Normal 80%
Abnormal 20% –> refer to hereditary cancer program
- Mutation 10%; no mutation 90%

24
Q

Indications for bilateral salpingo-oophorectomy in endomterial ca

A

Concurrent ovarian pathology
synchronous ovarian primary (low grade endometriod tumour), up to 25% (good prognosis)
Ovarian metastases less likely ~3%

25
Q

CI for bilateral salpingo-oophorectomy in endometrial ca

A

morbidity/mortality from early BSO

osteoporosis, CHD, lung and CRC

26
Q

HT after endometrial ca

A

Stage I/II/III: no increased risk with HRT

benefits > risks

27
Q

Protective factors for endometrial ca

A 
Multiparity (>3): 0.3 RR
OCP (5 y): 0.5
Exercise (2.5 h/week): 0.5
Smoking (current vs never): 0.7
Coffee (per cup): 0.9
28
Q

Immediate precursor to endometrial ca

A

Complex Atypical Hyperplasia

REPRO (18 decks)

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