Uterus/Endometrium

Question 1

Where is the uterus located?

Answer 1

The uterus is located in the pelvis between the bladder and rectum.

Question 2

What are the three parts of the uterus?

Answer 2

The uterus is divided into three parts: the body, cervix, and fundus.

Question 3

What are the three layers of the uterine cavity?

Answer 3

The uterine cavity is made up of three layers:
• Mucous membrane lining (endometrium)
• Smooth muscle layer (myometrium)
• Outer serous coat (perimetrium)

Question 4

Where do endometrial cancers originate?

Answer 4

Endometrial cancers originate from the endometrium layer of the uterus.

Question 5

What is the most common malignancy of the female genital tract?

Answer 5

Endometrial cancer.

Question 6

In which demographic is endometrial cancer most prevalent?

Answer 6

Postmenopausal women (55+).

Question 7

Which group has higher incidence rates of endometrial cancers?

Answer 7

Caucasian women, but African American women have a higher mortality rate.

Question 8

What type of cancers are endometrial cancers related to?

Answer 8

Hormone-related cancers.

Question 9

What is the major risk factor for endometrial cancers?

Answer 9

High cumulative exposure to estrogen.

Question 10

How much higher is the risk of developing endometrial cancer in obese women?

Answer 10

Threefold to fivefold higher.

Question 11

What are some other risk factors for endometrial cancer?

Answer 11

Estrogen replacement without progesterone, nulliparity, late menopause, early menarche, irregular menstruation, diabetes, history of infertility.

Question 12

What is the risk associated with women taking tamoxifen?

Answer 12

Higher risk for endometrial cancers.

Question 13

What hereditary condition increases the risk of endometrial cancer?

Answer 13

Hereditary colon cancer.

Question 14

What is the most common type of endometrial cancer?

Answer 14

Adenocarcinomas (70%)

Question 15

How do adenocarcinomas in endometrial cancer develop?

Answer 15

They evolve from endometrial hyperplasia or de novo.

Question 16

What are the types of tumors associated with endometrial cancer?

Answer 16

Sarcomas

Question 17

Name a type of endometrial sarcoma.

Answer 17

Endometrial stromal sarcoma

Question 18

What is another type of sarcoma related to endometrial cancer?

Answer 18

Mixed mesodermal

Question 19

What is a benign tumor associated with endometrial cancer?

Answer 19

Benign leiomyoma (fibroids)

Question 20

Is there a standard screening for endometrial cancer?

Answer 20

No standard screening for endometrial cancer.

Question 21

What are common symptoms of endometrial cancer?

Answer 21

Symptoms may include postmenopausal bleeding.

Question 22

At what stage are most endometrial cancers diagnosed?

Answer 22

Most endometrial cancers are diagnosed in stage 1.

Question 23

What is the diagnosis procedure for endometrial cancer?

Answer 23

Dilatation and curettage (D&C).

Question 24

What are the routes of spread for endometrial cancer?

Answer 24

Direct Extension, Lymphatic

Question 25

What structures can endometrial cancer directly extend to?

Answer 25

Myometrial wall, Cervix, Ovaries, Vagina, perimetrium, Bladder, Rectum

Question 26

Which lymph nodes are involved in the lymphatic spread of endometrial cancer?

Answer 26

External iliac nodes, Internal iliac nodes, Common iliac nodes

Question 27

What staging system is used for endometrial cancer?

Answer 27

International Federation of Gynecology and Obstetrics Staging System (FIGO) ## Footnote Also includes American Joint Committee on Cancer TNM staging system.

Question 28

What are the treatment options for endometrial cancer?

Answer 28

Surgery, Endocrine/Hormone Therapy, Chemotherapy, Intracavitary Radiation Therapy (Brachytherapy), External Beam Radiation Therapy, Immunotherapy.

Question 29

What factors determine the treatment approach for endometrial cancer?

Answer 29

The stage, grade, and medical condition of the patient.

Question 30

What is the treatment approach for early-stage endometrial cancer?

Answer 30

Surgery alone or in combination with adjuvant therapies can yield definitive results.

Question 31

What is a bilateral salpingo-oophorectomy?

Answer 31

Surgical removal of the fallopian tubes and the ovaries.

Question 32

What is the main hormone treatment for endometrial cancer?

Answer 32

The main hormone treatment for endometrial cancer uses progesterone.

Question 33

What are progestins used for in the context of endometrial cancer?

Answer 33

Progestins are a type of hormone treatment used for endometrial cancer.

Question 34

What is the role of chemotherapy in locally recurrent cancer?

Answer 34

Chemotherapy is used as a radiation sensitizer in locally recurrent cancer.

Question 35

What is the majority of recurrences in endometrial cancer associated with?

Answer 35

The majority of recurrences are distant metastasis to lung or bone with associated pelvic recurrence in 50%.

Question 36

What are the two types of brachytherapy used for endometrial cancer?

Answer 36

LDR brachytherapy and HDR brachytherapy.

Question 37

What is LDR brachytherapy?

Answer 37

The applicator with the radiation source is left in for about 1 to 4 days. The patient usually needs to stay in the hospital during treatment.

Question 38

What isotopes are used in intracavitary radiation?

Answer 38

Iridium-192 and Cesium-137.

Question 39

What is the function of the tandem applicator?

Answer 39

The tandem applicator holds sources within the uterine canal.

Question 40

What are ovoids or colpostats used for?

Answer 40

They hold sources within the vaginal fornixes.

Question 41

What areas are targeted in intracavitary radiation?

Answer 41

Uterus, cervix, and vagina.

Question 42

What techniques are used for implantation if the uterus is present?

Answer 42

Heyman capsule techniques or an intrauterine tandem are used for implantation.

Question 43

What devices are used for postoperative treatment in HDR for endometrial cancer?

Answer 43

A domed cylinder or vaginal Colpostats are used if brachytherapy is necessary.

Question 44

What is the half-life of Iridium 192 used in brachytherapy?

Answer 44

74 days

Question 45

What are typical LDR brachytherapy doses for endometrial cancer?

Answer 45

60-Gy to 70-Gy surface dose in two treatment sessions

Question 46

What are typical high-dose-rate brachytherapy dose fractions?

Answer 46

7 Gray to a 0.5-cm depth prescribed for three treatment sessions to a total of 21 Gy

Question 47

What is the energy range used for EBRT in endometrial cancer?

Answer 47

Energy - 10-18MV

Question 48

What are the techniques used in EBRT for endometrial cancer?

Answer 48

Techniques include: - Four field box - IMRT - VMAT

Question 49

What is the typical EBRT dose for endometrial cancer?

Answer 49

Typical EBRT dose is 45-50Gy with approximately 1.8Gy per fraction.

Question 50

What is the maximum dose for the endometrial cavity with combined therapy?

Answer 50

The endometrial cavity can be taken to 75 to 90 Gray with combined external beam therapy and low-dose-rate brachytherapy.

Question 51

What are the acute side effects of radiation treatment for endometrial cancer?

Answer 51

Fatigue, Diarrhea, Cystitis, Nausea, Anorexia, Vaginal dryness ## Footnote More common after vaginal brachytherapy than after pelvic radiation.

Question 52

What are the chronic side effects of radiation treatment for endometrial cancer?

Answer 52

Chronic cystitis, Proctosigmoiditis, Small bowel enteritis, Obstruction, Vaginal stenosis ## Footnote Caused by scar tissue, which can cause the vagina to become shorter and more narrow.