Uterine cancer

Question 1

What percent of new GYN cancers each year are endometrial?

Answer 1

50%

Question 2

What percent of female cancers, including breast cancer, every year are endometrial?

Answer 2

15%

Question 3

Risk factors for endometrial cancer

Answer 3

Nulliparity, infertility, anovulation, early menarche, late menopause, ERT (highest increased risk), Tamoxifen, obesity, granulosa cell tumors, other comorbidities (associated with obesity)

Question 4

Genetic risk factor for endometrial cancer

Answer 4

Hereditary non-polyposis colon cancer (HNPCC) syndrome (Lynch)

Question 5

Protective factors for endometrial cancer

Answer 5

Combination OCPs, pregnancy, cigarette smoking

Question 6

How many people present with uterine bleeding as first sign of endometrial cancer?

Answer 6

85%

Question 7

What other presenting signs are there for endometrial cancer? (3)

Answer 7

1. Endometrial cells on postmenopausal pap
2. Atypical endometrial cells on any pap
3. Pyometrium in postmenopausal woman

Question 8

Progression of hyperplasia to cancer (terminology)

Answer 8

Benign endometrial hyperplasia > endometrial intraepithelial neoplasia (EIN) > endometrioid adenocarcinoma

Question 9

Most common histology of endometrial cancer

Answer 9

Endometrioid (90%)

Question 10

What is different between EIN and cancer on histology?

Answer 10

Back-to-back glands

Question 11

FIGO surgical stages for endometrial cancer

Answer 11

I - confined to uterus
II - cervical stroma extension
III - pelvic extension
IV - mucosa of bladder or bowel or distant disease

Question 12

What proportion of patients are diagnosed with stage I endometrial cancer?

Answer 12

75%

Question 13

Modes of treatment and their indications

Answer 13

Surgery - local disease
Radiation - spread in pelvis
Chemo - spread systemically outside uterus

Question 14

Treatment for non-surgical candidate

Answer 14

Radiation alone (but survival is reduced)

Question 15

Treatment for non-surgical candidate with grade 1 disease

Answer 15

Progestin therapy (Megace or LNG-IUD)

Question 16

Most important prognostic factor for endometrial cancer

Answer 16

Lymph nodes (none 85%, pelvic LNs 65%, para-aortic LNs 45%)

Question 17

Other prognostic factors

Answer 17

Lymph node status, histologic type, depth of invasion, grade, peritoneal cytology (though no longer used for staging), ER/PR status, LVSI, age

Question 18

Survival type I vs type II

Answer 18

85% vs 50%

Question 19

Type I characterisitics

Answer 19

More common, median age 55, obese, PMB, estrogen-dependent, low-grade

Question 20

Type II characteristics

Answer 20

Less common, older patients, non-obese, not estrogen-dependent, serous or clear cell, high-grade, more likely metastatic

Question 21

Follow-up after treatment for endometrial cancer

Answer 21

Exam q3mos x2 yrs, then q6 mos till 5 yrs, then yearly

Imaging is not strictly recommended

Question 22

When do endometrial cancer recurrences occur?

Answer 22

80% occur in first 2 yrs

Question 23

Treatment for recurrence

Answer 23

Pelvic RT if none prior, add chemo if distant spread

Question 24

Chemo for endometrial cancer

Answer 24

Platinum, taxanes, doxorubicin

Question 25

Presentation of leiomyosarcoma (LMS)

Answer 25

Solitary solid mass with median size 10 cm, vaginal bleeding in 70% and pelvic pain 20%, cannot be sampled with EMBx

Question 26

Treatment for LMS

Answer 26

Hyst + BSO (though may preserve ovaries in younger women), relatively chemo and RT resistant

Question 27

Factors for prognosis of LMS

Answer 27

Extent of disease, size of tumor, mitotic activity (>10 per 10 hpf) Spreads hematogeneously

Question 28

Presentation for endometrial stromal sarcoma (ESS)

Answer 28

Premenopausal, AUB, thickened endometrium, dx by endometrial sampling

Question 29

Treatment for ESS

Answer 29

Hyst + BSO, no surgical staging required, consider progestin therapy

Question 30

Expected outcome for ESS

Answer 30

Indolent tumor, good prognosis (unless high-grade, then poor)

Question 31

Presentation for carcinosarcoma (MMMT)

Answer 31

Combo of sarcomatous and epithelial cell, large and bulky mass, median age >65 y/o, PM and pelvic pain, sometimes pedunculated mass through cervix

Question 32

Treatment for carcinosarcoma

Answer 32

Hyst + BSO, consider surgical staging, consider chemo

Question 33

Prognosis for carcinosarcoma

Answer 33

Poor, spread is common