Endometrial Cancer

Question 1

Risk of hyperplasia progressing to cancer

Answer 1

simple- 1%
Complex 3%
Simple with atypia 8%
Complex with atypia 29%

Question 2

What is the prevalence of existing endometrial cancer in patient’s with complex with atypia (EIN)

Answer 2

43% have current endometrial cancer

Question 3

Does turners syndrome have an increased risk for endometrial cancer?

Answer 3

yes

Question 4

treatment of endometrial hyperplasia without atypia

Answer 4

IUD

medroxyprogesterone 10 mg/day for 10 days

Question 5

treatment of hyperplasia with atypia

Answer 5

Hysterectomy
OR D&C to exclude cancer and IUD placement (or Depo)

Rebiopsy at 3 months

Question 6

What % of patients with postmenpausal bleeding have cancer?

Answer 6

10%

Question 7

If you get an ultrasound and lining is >11 mm what do you do?

Answer 7

Endometrial Biopsy

Question 8

If she does have postmenopausal bleeding and the lining is thin (<4mm) does it rule out cancer

Answer 8

No they can still have type 2 cancer

Question 9

Amsterdam Criteria for Lynch syndrome

Answer 9

3-2-1
3 associated cancers
2 or more generations
1 prior to 50

Question 10

Lynch and endometrial cancer

Answer 10

2% of endometrial cancers
MLH2 /1 or PMS
Lifetime risk of endometrial cancer is 30%
Tends to present 10 years younger (in 50’s)
7-10 % will have more than 1 cancer at diagnosis

Question 11

Cowden Disase

Answer 11

Rare
 Autosomal dominant, PTEN mutations
 Increase risk of
• Endometrial (type I)
• Breast cancer
• Thyroid cancer

Question 12

Basic Uterine staging

Answer 12

Stage 1- uterus
Stage 2- Cervical stroma
Stage 3- lymph nodes
Stage 4- Invades bladder /rectum or distant

Question 13

Grade 1 or 2 with superficial invasion what the risk for lymph node invasion

Answer 13

5%

Question 14

When to give just brachytherapy

Answer 14

Stage one with high risk factors:
Grade 2-3
• LVSI
• Outer third invasion
• Age: >70 1RF ; 50-70 2 RF

or Stage II

Question 15

When do you do radical hyst?

Answer 15

Known stage II prior to surgery

Question 16

Type 2 uterine cancer treatment

Answer 16

Taxol/carbo

Question 17

Surveillance after endometrial cancer

Answer 17

Low risk (stage IA grade 1 or 2)
• Every 6 months x 1 year, then annual
 Intermediate risk (stage IB)
• Every 3 months x 1 year, then every 6 months
 High risk (type II, Stage III or IV)
• Every 3 months x 2 years, then every 6
 Pap smear nor CA125 recommended
 CT/MRI as indicated clinically

Question 18

Screening with tamoxifen

Answer 18

only work up with abnormal bleeding

Question 19

lieomyosarcoma on hyst sample what to do?

Answer 19

Surveillance
Does not met to lymph nodes
recurrence is 50% regardless of treatment

Question 20

Low grade endometrial stromal sarcoma treatment

Answer 20

hormones

rads only if spread

Question 21

High Grade Endometrial stromal sarcoma treatment

Answer 21

Gemcitabine/Docetaxel
Radiation
recurrance is high