Endometrial Cancer Flashcards
(31 cards)
What are the high to high intermediate risk factors that would suggest a patient would benefit from vaginal brachytherapy?
Cervical stromal invasion, grade 2-3 endometrioid disease, LSVI, and myometrial invasion.
For Stage 1A w/grade 1-2 pathology, what is the adjuvant tx patients get after surgery? (endometrioid)
Per NCCN you can do observation (preferred). You can consider vaginal brachytherapy if there is LSVI and/or they are 60 or older.
For Stage IA disease (endometrioid) grade 3 disease what is the adjuvant tx after surgery?
Vaginal brachytherapy is preferred. You can consider observation if there is no myometrial invasion OR you can consider EBRT if LSVI or if 70 years or older (Cat2B)
What is the tx for Stage IB grade 1 disease after surgery?
Vaginal brachytherapy is preferred. Can consider observation if no LSVI and less than age 60.
What is the tx for Stage IB grade 2 disease after surgery (endometrioid)?
Vaginal brachytherapy is preferred. Consider EBRT if aged 60 or older and/or LSVI. Can consider observation for those less than age 60 and no LSVI.
What is tx for Stage IB and grade 3 disease after surgery (endometrioid type)?
EBRT and/or vaginal brachytherapy +/-chemo (Cat2B for chemo).
What is the tx of Stage II disease with Grade 1-3 pathology after surgery (endometrioid)?
EBRT (preferred) and/or vaginal brachytherapy +/- chemo (Cat2B rec for chemo).
What are the high risk histologic subtypes in endometrial cancers and how are they typically treated?
Serous, clear cell, carcinosarcoma, undifferentiated. They are treated with chemotherapy and usually a combination of EBRT and brachytherapy and surgery.
What is the management of Stage III/IV endometrioid Grade 1-3 disease?
After surgery they should receive systemic chemo +/-EBRT +/- vaginal brachytherapy
What is the tx for stage III/IV Uterine Serous Carcinoma and carcinosarcoma Her2+ disease?
Carboplatin/Paclitaxel/Trastuzumab. This was based off of a clinical trial that showed PFS improvement and OS benefit (in serous carcinoma), more so impactful in the upfront vs recurrent setting.
When is Carboplatin/Paclitaxel/Durvalumab indicated in advanced/metastatic disease?
This combo is approved for Stage III/IVA with measurable disease or for patients with Stage IVB w/ or w/o measurable disease as upfront therapy. dMMR is not required here.
When using Pembro/Lenvatininb in the second line setting, what is the survival data with this combo?
There is a significant improvement in PFS and OS. Only approved for recurrent setting after platinum combo.
What is the indication for Carboplatin/Paclitaxel/Dorstalimab in advanced/metastatic disease?
This is used for upfront therapy for IIIA, IIIB, IIIC1 w/measurable disease. Stage IIIC1-carcinosarcoma, serous, clear cell, mixed regardless of measurable dx. Stage IIIC2 or IV regardless of measurable dx.
When is hormone therapy indicated in metastatic disease?
You can use it for recurrent or metastatic disease, but only for those tumors with a low grade (e.g. grade 1/2) and very low tumor burden and endometrioid histology.
What is the preferred hormonal agent to use for endometrioid histology in the metastatic/recurrent setting? Other options?
Preferred-Megestrol Acetate alternating with Tamoxifen or Everolimus/ Letrozole. Others: Fulvestrant, Tamoxifen, AIs alone. Other progestins you can use also.
In ER+ endometrioid low grade tumors that are advanced/metastatic or recurrent what hormone combination can you use?
Letrozole/Ribociclib
Letrozole/Abemaciclib
For those women who desire fertility preservation or are not suitable for surgery and have uterine limited disease only, what is the option used to treat?
Levonorgestrel IUD is the preferred option. Can also used Megestrol Acetate or Medroxyprogesterone Acetate.
What is the tx for Stage IB-IV Carcinosarcoma? Stage IA?
Chemo (Carbo/Paclitaxel) +/- EBRT +/- Vaginal Brachytherapy. Stage IA-systemic therapy plus vaginal brachytherapy +/- EBRT
What is the tx of Stage IA carcinosarcoma?
Chemo (Carbo/Paclitaxel) plus vaginal brachytherapy +/- EBRT
When considering EBRT in carcinosarcoma, what pathology feature would make you more inclined to give this?
If both high grade epithelial components and sarcoma are dominant (>50% of sarcoma component in uterine tumor).
What is the management of Stage I Leiomyosarcoma? In general how responsive is this tumor to chemo and RT?
Surgery followed by observation. In general they are not super responsive to chemo or RT and have a 50% recurrence rate when confined to the uterus.
What is the tx for Stage II/III Leiomyosarcoma?
Consider observation if completely resected w/negative margins OR you can consider systemic chemo and/or EBRT
What is the tx for Stage IVA and IVB Leiomyosarcoma?
For stage IVA you can do systemic chemo and/or EBRT. For Stage IVB you do chemo +/-palliative EBRT.
Low grade endometrial stromal sarcomas can be treated with what therapy since they are low grade?
Hormonal therapy-AIs, Megestrol Acetate, medroxyprogesterone. Remember there are some tumors that can be high grade that need chemo like you would for Leiomyosarcoma.
