Endometrial Cancer

Question 1

endometrial cancer is staged ______

Answer 1

surgically (Cervical=Clinically)

Question 2

Pattern of spread for endometrial cancer:

Answer 2

direct extension (most common) and lymphatics; (can also be transtubal or hematogenous - lung is most common, also to liver, brain, bone)

Question 3

____ and ____ determine treatment of endometrial cancer

Answer 3

surgical staging and health of patient

Question 4

RF for endometrial cancer include:

Answer 4

• obesity

- unopposed stimulation of estrogen receptors

Question 5

Classic symptom of endometrial cancer

Answer 5

postmenopausal bleeding

Question 6

diagnosis of endometrial cancer is made by:

Answer 6

endometrial sampling

Question 7

most common type of endometrial cancer

Answer 7

Type 1 endometrial cancer (estrogen dependent)

Question 8

non-estrogen dependent endometrial cancer

Answer 8

Type II

Question 9

endometrial cancer with better prognosis

Answer 9

Type I (estrogen dependent)

Question 10

endometrial cancer more related to obesity

Answer 10

Type I (estrogen dependent)

Question 11

Most common site of recurrence (2)

Answer 11

vaginal or pelvic

Question 12

site of recurrence with best prognosis is:

Answer 12

isolated vaginal

Question 13

____ % recurrences occur within 2 years of treatment

Answer 13

50% (cervical is 80%)

Question 14

most common site of hematogenous spread

Answer 14

lung; (liver, brain, bone also common)

Question 15

peak age with highest prevalence

Answer 15

60-70 y.o.

Question 16

prevalence of endometrial cancer if

Answer 16

2-5%

Question 17

Risk factors for endometrial cancer:

Answer 17

unopposed estrogen therapy, late menopause, PCOS, obesity, DM, HNPCC

Question 18

protective factors for endometrial cancer:

Answer 18

combined OCPs (progestin); physical activity; pregnancy/breastfeeding; diet low in SF; smoking

Question 19

Type II endometrial cancer histo types:

Answer 19

• papillary squamous
• clear cell
• adenosquamous
• undifferentiated

Question 20

p53 mutations are most common in type __ endometrial cancer

Answer 20

type 2

Question 21

PTEN mutations, MSI are most common in type __ endometrial cancer

Answer 21

type 1

Question 22

mets found in peritoneum suggest type ___ endometrial cancer

Answer 22

type 2

Question 23

mets found in the LNs and ovarian involvement suggest type __ endometrial cancer

Answer 23

type 1

Question 24

type of endometrial cancer with a favorable prognosis

Answer 24

type 1

Question 25

atypical endometrial hyperplasia is the precursor lesion for type ___ endometrial cancer

Answer 25

type 1; type 2 has less defined precursor lesion

Question 26

type of endometrial cancer often with later onset (70s)

Answer 26

type 2; (type 1 presents in 50-60s)

Question 27

leiomyosarcoma

Answer 27

rapidly growing fibroid, should be evaluated

Question 28

MMMT

Answer 28

malignant mixed Mulerian tumor (carcinosarcoma)

Question 29

3 other types of uterine cancer:

Answer 29

- leiomyosarcoma - stromal sarcoma - carcinosarcoma (MMMT)

Question 30

symptoms of uterine cancer

Answer 30

- PMB - PM endometrial cells on cervical cytology - perimenopausal abnormal uterine bleeding (heavy or irregular) - premenopausal w abnormal uterine bleeding w history of anovulation

Question 31

PMB differential diagnosis includes:

Answer 31

- atrophic endometritis/vaginitis (low estrogen state) - endometrial/cervical polyps - exogenous use of estrogen or drugs which stimulate estrogen receptors (tamoxifen) - endometrial hyperplasia; endometrial cancer; other gyn cancers

Question 32

precursor to endometrial cancer is _____ and presents as ____

Answer 32

endometrial hyperplasia and endometrial intraepithelial neoplasia (EIN); abnormal bleeding

Question 33

benign irregular dilated glands (with or w/o atypia) indicate:

Answer 33

Simple endometrial hyperplasia or EIN

Question 34

proliferation of glands with irregular outlines, back to back crowding of glands (w/ or w/o atypia)

Answer 34

Complex endometrial hyperplasia or EIN

Question 35

43% of ______ endometrial hyperplasia harbor coexisting carcinoma

Answer 35

complex atypical hyperplasia

Question 36

work-up of endometrial cancer involves:

Answer 36

endometrial biopsy (need tissue=90% sensitive) +/- TVUS; if negative, observe; D&C for more sensitive; + = pre-opp assessment

Question 37

endometrial preoperative workup involves

Answer 37

labs, CT of abdomen/pelvis (if advanced disease suspected), CXR, EKG

Question 38

stage of endometrial cancer in uterine corpus

Answer 38

Stage I (Ia 1/2 myometrium)

Question 39

stage of endometrial cancer in uterine corpus and cervical stroma

Answer 39

stage II (does not go beyond uterus)

Question 40

endometrial cancer in serosa/adnexa, vagina and para-aortic lymph nodes is stage:

Answer 40

stage III

Question 41

endometrial cancer found in bladder/bowel mucosa and with distant mets is stage:

Answer 41

stage iv

Question 42

5 year survival for endometrial cancer found in vagina and para-aortic LNs is:

Answer 42

52-60% (stage III)

Question 43

5 year survival of stage IV endometrial cancer is:

Answer 43

14-17%; 3 % are diagnosed at this stage

Question 44

5 year survival of this stage is 81-91%:

Answer 44

stage I (72% are diagnosed at this stage)

Question 45

5 year survival of endometrial cancer found in cervix

Answer 45

71-78% (stage II)

Question 46

most important prognostic factor in clinically early endometrial cancer is: -LN mets; histo type (papillary serous/ clear cell or HG endometroid); deep mometrial invasion; tumor size; lymphovascular space invasion or only adnexal invovement?

Answer 46

``` LN metastasis (40% decrease in 5 year survival and 6 fold higher recurrence rate); -all others are also prognostic factors ```

Question 47

primary treatment of endometrial cancer is surgery or radiation?

Answer 47

surgery: hysterectomy/BSO/+-pelvic/paraaortic LND (PPLND)

Question 48

primary radiation is indicated in endometrial cancer patients that:

Answer 48

cannot tolerate surgery (3-5% of patients)