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Endometrial > Work-up Staging > Flashcards

Flashcards in Work-up Staging Deck (18)
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1
Q

Per the NCCN (2014), what is the workup for endometrial cancer?

A
  1. CBC,
  2. PAP smear
  3. Endometrial Bx
  4. CXR.

If extrauterine Dz is suspected, consider:

  1. CA125
  2. MRI/ CT
  3. Cystoscopy
  4. Sigmoidoscopy.
2
Q

What are the sensitivity and specificity of an endometrial Bx?

A

90%– 98% sensitivity and 85% specificity.

3
Q

When is D& C recommended?

A

endometrial Bx is nondiagnostic.

4
Q

What is involved in the surgical staging of pts with endometrial carcinoma?

A

Surgical staging for endometrial cancer:

  1. Vertical incision/ or laparoscopy
  2. Peritoneal washing/ cytology (controversial)
  3. Exploration of all peritoneal surfaces with Bx of any lesions
  4. Total abdominal hysterectomy (TAH)/ bilateral salpingo-oophorectomy (BSO)
  5. Uterus bivalved in operating room
  6. Omental Bx (omentectomy for uterine papillary serous carcinoma [UPSC]/ clear cell carcinoma [CCC])
  7. Pelvic/ P-A LN sampling vs. dissection.
5
Q

During the surgical staging procedure for endometrial cancer, what features are an indication for P-A nodal sampling? Approximately what % of pts have these features?

A

P-A sampling should take place in endometrial cancer pts with the following:

  1. Gross P-A Dz
  2. Positive pelvic LN
  3. Gross adnexal mass or peritoneal disease
  4. More than one-third myometrial involvement

~ 25% of pts have these features, but they account for 98% of all positive P-A LNs.

6
Q

Cystoscopy or sigmoidoscopy indicated when?

A

Sx or Advanced lesions per NCCN

7
Q

Staging of Endometrial Cancer

A
  • Stage T1a/ IA: limited to endometrium or less than one-half of myometrium
  • Stage T1b/ IB: invades half or more of myometrium Note: Endocervical glandular involvement only is considered AJCC T1 and FIGO stage I.
  • Stage T2/ II: invades connective tissue of cervix but does not extend beyond uterus
  • Stage T3a/ IIIA: tumor involves serosa and/ or adnexa by direct extension of mets
  • Stage T3b/ IIIB: vaginal involvement or parametrial involvement
  • Stage T4/ IVA: tumor invades bladder mucosa (bullous edema is not sufficient) and/ or bowel mucosa
  • Stage N0: no regional LN mets
  • Stage N1/ IIIC1: regional LN mets to pelvic nodes
  • Stage N2/ IIIC2: regional LN mets to P-A nodes
  • Stage M1/ IVB: DMs Note: Per the AJCC 7th edition (2011) and FIGO (2008), positive cytology no longer alters stage.
8
Q

Stage 1A

A

<1/2 myometrium or limited to endometrium

9
Q

Stage 1B

A

1/2 or more of of myometrium involvement

Note: Endocervical glandular involvement only is considered AJCC T1 and FIGO stage I.

10
Q

Stage II

A

Invades conective tissue of cervix but does not extend beyond uterus

11
Q

Stage T3a or FIGO IIIA

A

Involves serosa or adnexa by direct extension of mets

12
Q

T3b/FIGO IIIB

A

Vaginal involvement or parametrial involvement

13
Q

IIIC1/N1

A

Pelvic LN

14
Q

IIIC2

A

PA nodes

15
Q

IVA/T4

A

Invades bladder mucosa

16
Q

IVB

A

Distant Mets

17
Q
A
18
Q

Old Staging

A
  • 1A- limited to endometrium
  • 1B <1/2 endometrium
  • 1C > 1/2
  • Stage II Endocervical glands only
  • IIB endocervical stromal invasion
  • IIIA- invades serosa or adenexa or cancer cells in ascites or peritoneal washings
  • IIIB vaginal involvement
  • IIIIC mets to Pelvic or PA LN
  • IVA bladder/bowel mucosa
  • IV mets