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GYN > Endometrial > Flashcards

Endometrial Flashcards

1
Q

What mutations should be tested

A

mismatch repair mutations (MMR), p53, POLE (favorable)

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1
Q

Desribe the two main types

A

Type 1: endometrioid adenocarcinoma (70-80%) of patients. Estrogen-related

** Type 2:** serous, clear cell. Higher grade tumors. Not estrogen-related. More aggressive clinical course

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2
Q

What are negative prognostic indicators

A
  1. Age >60
  2. grade 3
  3. Over 50% myometrial invasion
  4. LVSI
  5. large tumor
  6. non endometroid histology
  7. Lower uterine segment invovlement
  8. poor PS
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3
Q

What % of patients with pelvic nodes have PALN

A

30-50%

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4
Q

Describe the staging for endometrial carcinoma

A

1A: < 50% myometrial invasion
1B: > 50%

II: Invades cervical stroma but not beyond the uterus

IIIA: uterine serosa/adnexa
IIIB: vagina/parametrium
IIIC1: pelvic node +
IIIC2: paraaortic node +

IVa: bowerl/bladder invasion
IVb: distant mets

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5
Q

What is the general tx paradigm

A

Surgery fist: Total abdominal hysterectomy + bilateral salpingo-oophorectomy

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6
Q

Does peritoneal cytology affect staging?

A

No, but should be reported

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7
Q

What does surgery involve

A

Most patients get a simple extrafascial hysterectomy and a BSO and if they have cervical stromal involvement then a modified radical hysterectomy will be performed

peritoneal cytology will be collected

Omendatl biopsy should be obtained and a omentectomy performed if papillary serous or clear cell histology

Pelvic LN evaluation: SLN biopsy, PLND (paraortic node evaluation if pelvic node +)
PET/CT or CT AP should be done before

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8
Q

What is the adjuvant therapy for stage 1A, G1-G2

A

Observation
VCB if >70 and/or
if LVSI ( Per GOG 99)

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9
Q

What is the adjuvant therapy for
Stage 1A, Stage IA, G3
Stage IB, G1-2G3

A

VCB ( Per Portec 1 and 2)

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10
Q

What is the adjuvant tx for Stage IB, G3

A

Pelvic EBRT +/- VCB

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11
Q

What is the adjuvant tx for Stage II

A

Pelvic EBRT +/- VCB or chemo+VCB

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12
Q

What is the adjuvant tx for Stage III-IVA

A

Sandwich chemotherapy -> EBRT + VCB–> chemotherapy

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13
Q

How to treat inoperable

A

Pelvic EBRT + intracavitary brachytherapy boost +/- chemo

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14
Q

When to add VCB

A

> 50% myometrial invasion
G3
serious/clear cell ( treated as G3)
cervical/vaginal invasion
LVSI
especially if the pt is over 70

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15
Q

When to add pelvic EBRT

A

if >50% and G3
Cervical stromal invasion
positive margin
locally invasive

16
Q

When to add chemo

A

If locally invasive, LN+

17
Q

What is the vaginal cuff brachy dose alone

A

21 Gy/3 fracctions prescribed to 5 mm depth, treat proximal 4 cm of vagina

18
Q

What is the vaginal cuff brachy dose with EBRT

A

10 Gy/2 fx

19
Q

Describe pelvic EBRT volumes for endometrial cancer

A

CTV 45 Gy: pelvis ( proximal half of vagina+paravaginal + parametria, lymph nodes)

If cervical stromal invasion- add presacral (superior border L4/L5)

If uterine fundus- include paraaortics

If distal vagina- then include all of vagina and inguinal nodes

Include 1 cm of posterior bladder and anterior rectum

7mm around the nodes

20
Q

What nodes to include if cervical stromal invasion

A

then add presacral nodes, upper border L4/L5- S3

21
Q

What nodes to include if fundus invasion

A

paraaortic nodes as it can directly drain there

22
Q

What if distal vaginal involvement

A

Include all of the vagina and inguinal nodes

22
Q

what is the nodal boost dose

A

CTV5625/25fx

23
Q

What are the PTV expansions

A

5 mm

24
Q

How is chemotherapy given in endometrial cancer

A

Sandwich approach was preffered at Mayo

3 cycles of carboplatin/paclitaxel before and 3 cycles after RT

if giving concurrently, then give weekly cisplatin

25
Q

How is EBRT for definitive tx done

A

Pelvic EBRT including uterus and adnexa ( proximal vagina, paravaginal tissues, parametria, pelvic nodes_

26
Q

How is the intracavitary brachy boost done for definitive tx

A

Using a route Y dual tandem applicator
Dose of 8.5 Gy x 2 fractions to uterus, cervica, prxomal 1-2 cm vagina

EQD2 of 70 Gy to gross disease with 45 Gy/25 fx+8.5 Gy/2 fx

27
Q

How to treat a vaginal cuff recurrence

A

EBRT if no prior RT
brachy with needles or cylinder- 6 Gy x 4 fx or 5 Gy x 5

28
Q

What are the outcomes of early stage endometrial cancer

A

5 year OS is 85%
5 year vaginal cuff recurrence after VCB is 2%

29
Q

What are the outcomes of advanced stage endometrial cancer

A

5 year OS is 80%
serous has a OS of 70%

GYN (4 decks)

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