Term
| what is the most common gyn malignancy in the US? |
|
Definition
|
|
Term
| what is the most common sign of endometrial CA? |
|
Definition
|
|
Term
| who typically gets endometrial CA? |
|
Definition
| 75% postmenopausal females (50-59 y/o). if in premenopausal 25% - pt likely has PCOS, morbid obesity, DM or genetic component (HNPCC) |
|
|
Term
| what are the most important prognostic factors for endometrial CA? what is the avg prognosis? |
|
Definition
| staging (extent of nodal spread) and grade (pathologic dx from bx 1-3). most endometrial CA is caught early on, so generally the prognosis is good. |
|
|
Term
| what characterizes type I endometrial CA? |
|
Definition
| typically endometrioid, low-grade, and estrogen-related |
|
|
Term
| what characterizes type II endometrial CA? |
|
Definition
| typically *papillary serous or *clear cell, high-grade, not related to estrogen, and have a higher propensity for being found outside the uterus. |
|
|
Term
| what are the risk factors for type I endometrial CA? |
|
Definition
| exogenous estrogen (postmenopausal women treated w/unopposed estrogen have 10x risk), endogenous estrogen (obesity, functional ovarian tumors), chronic anovulation (PCOS), tamoxifen (estrogen receptor antagonist in breast tissue/agonist in endometrium), HTN, DM, breast CA, age > 50 y/o, and fam hx of HNPCC |
|
|
Term
| what characterizes total CA risk w/HNPCC (hereditary non-polyposis colon CA)? |
|
Definition
| most common CA risk: colon CA @ 45 y/o, next most common: endometrial CA in 30s. *recommend colonoscopy for a younger endometrial CA pt. other associated CA: ovary, stomach, small bowel, and pancreas. |
|
|
Term
| what characterizes the synchronous relationship between ovarian and endometrial CA? |
|
Definition
| women w/ovarian or endometrial CA have a higher risk of developing the other. this usually happens more in younger pts. |
|
|
Term
| what are protective factors for endometrial CA type I? |
|
Definition
| exercise (increases testosterone/decreases estrogen), smoking (not recommended for obvious reasons), and OCPs (even more protective if started at younger age - effect due to progesterone) |
|
|
Term
| what is staging for endometrial CA? (*test question*) |
|
Definition
|
|
Term
| is routine screening for endometrial CA recommended? |
|
Definition
| no - due to a lack of an appropriate, cost-effective, and acceptable test that reduces mortality. |
|
|
Term
| what is the clinical presentation of endometrial CA? |
|
Definition
| *abnormal uterine bleeding, (which is the most common presentation of endometrial CA - even though the cause is more often atrophy) and *endometrial cells on a pap smear (not diagnostic, just indicates need for further evaluation). |
|
|
Term
| how is endometrial CA diagnosed? |
|
Definition
| endometrial bx (high sensitivity, well tolerated, cheap), D&C hysteroscopy (higher yield, higher complications), and US (*look for 20mm+ endometrial thickness, normal is 4-5mm - but not diagnostic). further workup: MRI is best for *assessing myometrial invasion/cervical involvement and CA-125 is useful for *estimating extrauterine/nodal spread: > 20 is generally indicative of a necessary lymphadenectomy. (CT = unecessary) |
|
|
Term
| what histologic type of endometrial CA has the best response to tx? |
|
Definition
| endometrioid (adenocarcinoma), which is also the most common, has the highest survival rate at all stages. |
|
|
Term
| does the size of a clear cell/papillary serous endometrial CA change its prognosis? |
|
Definition
| no, they are equally aggressive independent of size |
|
|
Term
| what is papillary serous endometrial CA like? |
|
Definition
| ovarian CA - which papillary serous endometrial CA *has to be staged like* |
|
|
Term
| what is the primary tx for endometrial CA? |
|
Definition
| surgery is the primary tx modality. most pts should have a full surgical staging - including complete lymph node dissection. this has been shown to be both diagnostic and improve survival. if a pt is not a surgical candidate (numerous co-morbid factors), radiation w/disease confined to the uterus has a 70% 5 yr survival rate. |
|
|
Term
| why is surgical staging important w/endometrial CA? |
|
Definition
| preop staging is often not extensive enough: stage I is upstaged 30% of the time and stage II/III is upstaged 60% of the time w/sx. this can range from a sampling to complete lymphadenectomy, and since the latter can cause lymphedema, it is reserved for grade III pathology only (pelvic sampling for all else). |
|
|
Term
| what lymph nodes specifically require attention in surgical staging of endometrial CA? |
|
Definition
| the status of both the *pelvic and *paraaortic lymph nodes should be assessed intraoperatively in all pts - at least by inspection and palpation, but histologic evaluation should be the standard. these nodes are from: distal common iliac, proximal external iliac arteries/veins, obturator fossa, and paraaortic nodes from the inferior mesenteric artery to the mid common iliac artery and renals. |
|
|
Term
| what are surgical complications w/endometrial CA? |
|
Definition
| *lymphedema, which can lead to venous stasis and wound breakout of the lower extremities (worse if complete lymphadenectomy + radiation tx) however, there is a low overall risk: 1.2%. *lymphocele, which arise from surgical transection/inadequate ligation of draining lymphatics and appear as large pelvic cysts (tx: usually can be drained percutaneously). |
|
|
Term
| what is low risk endometrial CA? (*be familiar w/this*) |
|
Definition
| stage IA: grade I or II histology w/o myometrial involvement. stage IB: invasion through <1/2 of the myometrium. stage IA: grade III w/o myometrial invasion. these are characterized by: disease confined to uterine fundus, no involvement of lymphovascular space, and no evidence of lymph node metastases. |
|
|
Term
| what is tx for low risk endometrial CA? |
|
Definition
| TAH BSO. adjuvant RT (vaginal brachytherapy) is suggested for women w/high risk of vaginal recurrence (eg, stage IA grade III disease) |
|
|
Term
| what is intermediate risk endometrial CA? |
|
Definition
| stage IC: grade I/II tumor beyond 1/2 through the myometrium. stage II w/invasion of the cervix/isthmus. intermediate risk is characterized by no involvement of the lymphovascular space and no evidence of metastases. |
|
|
Term
| what is tx for intermediate risk endometrial CA? |
|
Definition
| no definitive guidelines, but extrafascial TAH-BSO w/pelvic and paraaortic lymph node evaluation is current TOC. |
|
|
Term
| what is high risk endometrial CA? (*be familiar w/this*) |
|
Definition
| grade III CA w/any degree of myometrial invasion. grade II disease w/invasion beyond 1/2 of the myometrium and isthmic, cervical, or vaginal involvement. adnexal or pelvic mets. involvement of the lymphovascular space. |
|
|
Term
| what is tx for high risk endometrial CA? |
|
Definition
| TAH-BSO, pelvic RT and possible chemo |
|
|
