Term
| average age of endometrial polyps |
|
Definition
|
|
Term
| rate of malignancy in endometrial polyps |
|
Definition
|
|
Term
| most common location endometrial polyps |
|
Definition
|
|
Term
| symptoms of endometrial cancer and pre-cancer (4) and most common |
|
Definition
| PMP bleeding (90%), purulent DC (pyometrial), pain, asymptomatic (5%) |
|
|
Term
| causes of PMP bleeding (3) and most common |
|
Definition
| atrophy (#1), cancer (10%), polyps |
|
|
Term
| pathologic diagnostic criteria for EIN (3) |
|
Definition
glands > stroma (<55%)
crowded focus on cytology
>1mm linear dimension |
|
|
Term
| types of diagnosis for EIN and their accuracy (5) |
|
Definition
TVUS 99% perdictive
EMBx 90% accurate, misses cancer 45%
D+C 90%, 27% misses cancer
HSC 35% misses cancer
HSC + D+C best method |
|
|
Term
| when to do EMBX and D+C for PMP bleeding |
|
Definition
>4mm EMS do EMBx if symptomatic or has risk factors and asymptomatic
if insufficient sample and symptomatic do D+C
if symptomatic and persistent but <4mm sample, could have type II cancer |
|
|
Term
| types of hyperplasia and progression to cancer |
|
Definition
simple 1%
simple w atypia 8%
complex 3%
complex w atypia 40% - 50% have cancer somewhere not sampled 11% with deep invasion |
|
|
Term
| path of simple hyperplasia (4) |
|
Definition
| cystic dilation, slight crowding, occasional outpouching, abundent stroma |
|
|
Term
| path of simple hyperplasia w atypia (5) |
|
Definition
nuclear atypia with loss of polarity
increased nuclear to cytoplasm ratio
irregular shape and size
coarse chromatin clumping
prominent nucleoli |
|
|
Term
| path of complex hyperplasia (3) |
|
Definition
proliferation of glands
highly complex crowded glands
intervening stroma |
|
|
Term
| management of hyperplasia without atypia first line |
|
Definition
| progesterone (at least 12d per month) + endometrial sampling q3mo |
|
|
Term
| regression rate of hyperplasia without atypia with treatment |
|
Definition
|
|
Term
| management of hyperplasia without atypia second line |
|
Definition
| extrafascial hysterctomy with cervix no morcellation |
|
|
Term
| management of hyperplasisa with atypia |
|
Definition
| extrafascial hysterectomy with frozen, staging option must be available, refer if not in house |
|
|
Term
| types of uterine cancer (2) |
|
Definition
|
|
Term
| types of epithelial uterine cancer (4) |
|
Definition
type 1 - endometroid endometrial adenocarcinoma
type 2 - serous, clear cell, carcinosarcoma |
|
|
Term
| types of mesenchymal uterine cancer (5) |
|
Definition
| ESS, STUMP, undifferentiated, adenosarcoma, leiomyosarcoma |
|
|
Term
| incidence and mean age of epithelial endometrial cancer |
|
Definition
|
|
Term
| pathogenesis of type 1 uterine cancers (4) |
|
Definition
inactivation of PTEN
mutations in B-catenin
mutationsin KRAS
DNA mismatch repair - lynch |
|
|
Term
| risk factors for type 1 uterine cancer (3 categories broken down) |
|
Definition
unopposed estrogen (PCOS, tumor, obesity, DM2, iratogenic, late menopause, early menarche, tamoxifen, nulliparity, infertility, HTN)
age
genetic (lynch, cowden, BRCA) |
|
|
Term
| risk reduces for type 1 uterine cancer (2) |
|
Definition
|
|
Term
| incidence of the types of epithelial uterine cancers |
|
Definition
|
|
Term
| pathogenesis if papillary serous uterine cancer (2) |
|
Definition
TP53 mutation
HER2/neu amplification |
|
|
Term
| risk factors for type 2 uterine cancer (4) |
|
Definition
| age, smoking, AA, atrophy |
|
|
Term
| 5y survival for type 2 uterine cancer |
|
Definition
|
|
Term
| percent of type 2 uterine cancer that have mets on initial presentation |
|
Definition
|
|
Term
| recurrence rate type 2 uterine cancer stage 1 |
|
Definition
|
|
Term
| recurrence rate type 2 uterine cancer stage 2+ |
|
Definition
|
|
Term
| when do you get a CA125 in patients with uterine cancer (2) |
|
Definition
|
|
Term
| when pelvic nodes are positive, what percent of the time will paraaortic nodes be positive |
|
Definition
|
|
Term
| what percent of the time with paraaortic nodes be positive and pelvic nodes be negative |
|
Definition
|
|
Term
| what are the borders of a pelvic LND (4) |
|
Definition
| distal 1/2 of common iliac, external iliacs, deep circumflex vein, obturator nerve |
|
|
Term
| what are the borders of paraaortic LND (6) |
|
Definition
| IVC, inferior mesentric arery, right common iliac, aorta, L ureter, L common iliac |
|
|
Term
| what is optimal cytoreduction |
|
Definition
| <1cm visible residualo disease |
|
|
Term
| what are complications of pelvic LND (3) |
|
Definition
| vascular/nerve injury, lymphedema 47%, cellulitis |
|
|
Term
| in pelvic LND how can you reduce risk of lymphedema |
|
Definition
| limit dissection to cephalad to deep circumflex iliac avoiding circumflex iliac nodes |
|
|
Term
| what is the risk of ovarian malignancy in patients with endometrial cancer |
|
Definition
|
|
Term
| should you take the ovaries in endometrial cancer surgery |
|
Definition
pre-menopausal - no, consider if non-endometroid type
post- menopausal - yes |
|
|
Term
| if endoemtrial cancer is diagnosed after hysterectomy, who do you have to go back and do staging for (4) |
|
Definition
extrauterine spread
recurrant disease
grade 3
deep invasion |
|
|
Term
| what is the chemo used for endometrial cancer |
|
Definition
|
|
Term
| what is the staging for endometrial cancer |
|
Definition
1A - <50% invasion
1B - >50% invasion
2 - cervical stroma
3A - serosa or adnexa
3B - vagina or parametrium
3C1 - pelvic nodes
3C2 - paraaortic nodes
4A - bladder, bowel not intraperitoneal
4B - distant meds, upper abdomen, inguinal nodes |
|
|
Term
| what is the treatment for endometrial cancer stages 3+ after surgery |
|
Definition
3-4A - ERBT +/- brachytherapy +/- systemic therapy
4B - systemic therapy +/- ERBT +/- brachytherapy |
|
|
Term
| what is the treatment for stage 2 endomoetrial cancer after surgery |
|
Definition
brachytherapy +/- ERBT
consider systemic therapy if grade 3 |
|
|
Term
| what is the treatment for stage 1 endometrial cancer |
|
Definition
determine if low or high intermediate risk - if low risk no brachytherapy, if high risk then brachytherapy
- if grade 3 consider systemic therapy |
|
|
Term
| define low intermediate risk endoemetrial cancer |
|
Definition
| confined to the uterus, may invade cervical stroma |
|
|
Term
| define high intermediate risk endometrial cancer GYN-ONC group |
|
Definition
| deep invasion, grade 2-3, LVSI, >70yo |
|
|
Term
| define high intermediate risk endometrial cancer post-op rad group |
|
Definition
| >60yo, >50% invasion, grade 3 |
|
|
Term
| what is the difference in local recurrence, distant mets, and survival in the low vs high intermediate risk endometrial cancers |
|
Definition
local recurrence 5 to 3%
distant mets 8 to 6%
5y survivaL 78 to 83% |
|
|
Term
| what are the criteria for someone with endoemtrial cancer to qualify for fertility sparing management (4) |
|
Definition
limited to uterus on MRI/TVUS
grade 1
no contraindications to medical management
diagnosis is by D+C |
|
|
Term
| what is the management if fertility sparing for endometrial cancer (4) |
|
Definition
| progesterone, q3-6mo D+C vs EMBx, hysterectomy after childbearing, if cancer is still present on biopsy after 6-12mo do hysyterectomy now |
|
|
Term
| what is the rate of complete response, pregnancy rate, and recurrence in patients who did fertility sparing management for endometrial cancer |
|
Definition
complete response 76%
rercurrence 25%
pregnancy 35% (18% req ART) |
|
|
Term
| how do you manage someone with endometrial cancer that is a poor surgical candidate |
|
Definition
| ERBT +/- brachytherapy +/- systemic therapy |
|
|
Term
| what is the surveillance after endometrial cancer treatment |
|
Definition
exam q3-6mo for 2-3y then q6mo or annual
CA125 if was initially elevated
image for clinical concerns |
|
|
Term
| what are the signs of recurrent endometrial cancer |
|
Definition
|
|
Term
| what are the typical locations of recurrent endometrial cancer |
|
Definition
| 85% vaginal cuff, if at another site 70% will have symptoms |
|
|
Term
| what are the general principals of treatment for recurrent endometrial cancer |
|
Definition
secondary cytoreduction improves survival
TAP (taxol, adrimycin, platin) is used if chemo is indicated
if disseminated can do hormonal therapy, systemic therapy or palliative ERBT |
|
|
Term
| what is the incidence of uterine sarcomas |
|
Definition
|
|
Term
| what is the average age of diagnosis of uterine sarcomas |
|
Definition
|
|
Term
| what are the risk factors for uterine sarcomas (2) |
|
Definition
| tamoxifen >5y, pelvic radiation (5-10%) |
|
|
Term
| what are the symptoms of uterine sarcomas (6) |
|
Definition
| vaginal bleeding, pain, pressure, enlarged uterus, mass protruding through the cervix, rapidly enlarging uterus (rare) |
|
|
Term
| how are uterine sarcomas staged |
|
Definition
1A - <5cm limited to uterus
1B - >5cm limited to uterus
2A - adnexa
2B - pelvic tissues
3A - abdominal tissues 1 site
3B - abdominal tissues >1 site
4A - bladder/rectum
4B - mets |
|
|
Term
| what is a mitotically active leiomyoma |
|
Definition
not cancer
<5 mitosis per 10 HPF |
|
|
Term
|
Definition
smooth muscle tumor of uncertian malignant potential
<10 mitosis per 10 HPF |
|
|
Term
| what is the risk a STUMP will turn into cancer |
|
Definition
|
|
Term
| what is the pathological criteria for a STUMP (3) |
|
Definition
tumor cell necrosis in typical fibroid
<10 mitosis per 10 HPF
diffuse atypia |
|
|
Term
| what can cause a benign fibroid to look like a STUMP pathologically (3) |
|
Definition
| TXA, GNRH agonists, progesterone |
|
|
Term
|
Definition
| hysterectomy if does not desire childbearing then semiannual imaging for 5y |
|
|
Term
| what is the recurrence rate of a STUMP |
|
Definition
|
|
Term
| what is the histologic criteria for a leiomyosarcoma (3) |
|
Definition
>10 mitosis per 10 HPF
coagulative tumor necrosis
cytologic atypia |
|
|
Term
| what is the 5y survival for leiomyosarcoma in stage 1 and stage 2+ |
|
Definition
|
|
Term
| how is an endometrial stromal sarcoma managed |
|
Definition
| low grade, indolent, rare mets, often ER/PR positive, responsive to hormonal therapy |
|
|
Term
| what is a malignant mixed mullerian tumor of the uterus |
|
Definition
| a carcinosarcoma - usually high grade serous carcinoma and a high grade stromal carcinoma (may contain multiple carcinomas - endometroid clear cell) (may contain multiple sarcomas (leio, endometria, rhabdo, chondro, osteo, lipo) |
|
|
Term
| what is the recurrent rate of carcinosarcoma |
|
Definition
|
|
Term
| what percent of carcinosarcoma has nodal mets and extranodal mets |
|
Definition
|
|
Term
| what is the 5y survival for carcinomoasarcoma at stage 1 and stage 2+ |
|
Definition
|
|
Term
| how is carcinomasarcomoa treatment |
|
Definition
| unless confined to a polyp with no residual, everyone gets chemo (carboplatin/paclitaxel) |
|
|
Term
| how do you manage uterine sarcooma if it was diagnosed after hysterectomy |
|
Definition
imaging - see if residual disese MRI/PET/CT
resection of remaining disease and GYN structures (ovaries, cervix, tubes) |
|
|
Term
| what is the surveillance after uterine sarcoma treatment |
|
Definition
exam q3mo for 3y then q6-12mo
CT q3mo for 3y then q6-12mo for 2y then annual then biannual
estrogen blockade in stage 2+ |
|
|
Term
| where is uterine sarcoma likley to recur |
|
Definition
|
|
Term
| what is the recurrent rate for uterine sarcoma at stage 1 and 2+ |
|
Definition
|
|
Term
| what are the general principals for treating recurrent uterine sarcoma |
|
Definition
| resect remaining disease, follow with systemic therapy +/- ERBT |
|
|
Term
| at what EMS should you do an EMBx regardless of bleeding in PMP |
|
Definition
|
|
Term
| % of pregnancies affected by fibroids |
|
Definition
|
|
Term
| % of women with a fibroid in their lifetime |
|
Definition
|
|
Term
| % of AA and white women with a fibroid in their lifetime |
|
Definition
|
|
Term
| % of fibroids that become symptomatic |
|
Definition
|
|
Term
| 1# complication of fibroids in pregnancy |
|
Definition
|
|
Term
| complications of fibroids in pregnancy - 6 |
|
Definition
| CD, abruption, breech presentation, PPH, increase in size in 2T, pain |
|
|
Term
| % of patients in pregnancy hospitalized for fibroid pain with fibroids |
|
Definition
|
|
Term
| after growth in pregnancy, how long does it take fibroids to return to their usual size |
|
Definition
|
|
Term
| effect of GNRH agonist on fibroids |
|
Definition
| decreased size 30-60% (temporary), increased Hbg with use of Fe |
|
|
Term
| effect of OCPs on fibroids |
|
Definition
| decreased bleeding but not anemia |
|
|
Term
| effect of depo on fibroids |
|
Definition
|
|
Term
| effect of mirena on fibroids |
|
Definition
| decreased bleeding, increased Hbg/fettitin, decreased uterine but not fibroid size, increased expulsion |
|
|
Term
| effect of mifirpstone on fibroids |
|
Definition
| less bleeding, more endometrial hyperplasia |
|
|
Term
| effect of urlipristol on fibroids |
|
Definition
|
|
Term
| how much does US treatment of fibroids decrease size |
|
Definition
|
|
Term
| how much does UAE for fibroids decrease size |
|
Definition
|
|
Term
| criteria for hysterectomy for fibroids |
|
Definition
| need 1 - palpable and of concern to the patient, HMB/flooding or bleeding >7d, anemia |
|
|
Term
|
Definition
0 - pedunculated inside uterus
1 - <50%, not touching anything
2 - >50%, not touching anything
3 - >50%, touching endometrium
4 - >50%, touching endometrium, bigger? |
|
|
Term
|
Definition
5 - >50% touching serosa
6 - <50% touching serosa
7 - pedunculated outside uteruses
8 - cervical or broad ligament |
|
|
Term
| what types of fibroids cause HMB and infertility |
|
Definition
|
|
Term
|
Definition
|
|
