Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
15 Cards in this Set
- Front
- Back
|
Define Type I versus Type II endometrial cancer.
|
Type I = younger/perimenopausal women, better differentiated, ER/PR positive
Type II = older women, poorly diff or papillary serous or clear cell. worse prognosis, older/thin PM women. |
|
|
What percent of patients with post-menopausal bleeding have cancer?
What percent per age group: 50s, 60s, 70s, 80s? |
10% of pts with PMB have Cancer
50s: 9% 60s: 16% 70s: 28% 80s: 60% |
|
|
What is the diagnostic accuracy of EMB for diagnosing EM cancer?
|
93-98%
|
|
|
What should be done if PMB recurs after a negative endometrial biopsy?
|
Perform a D&C
|
|
|
What are options for progesterone treatment for hyperplasia?
|
Provera 10-20 mg PO daily or Megace 20-40 mg daily
|
|
|
What should be done for complex atypical hyperplasia? surgical planning?
|
peritoneal cytology and intraop frozen section at time of hyst, consent for possible nodes
|
|
|
What dose of Megace can be used in patients who are poor surgical candidates?
|
160 mg QD in divided doses for 3 mos, then resample
|
|
|
What are the subtypes of endometrial cancer? How aggressive are they?
|
1. Endometriod adenoca (80%)
- variants: w sq differentiation (15-25%, good prognosis); villoglandular or papillary (2%), ssecretory (1%) 2. Mucinous (5%) 3. Pap Serous (5-7%) - aggressive, if >25% of tumor is PS = aggressive. High percent of deep myometrial invasiaon, 50% have extrauterine dz at surgery, 75% have LVSI. 4. Clear cell (3%) aggressive, but similar to grade 3 endometriod |
|
|
What is the incidence of synchronous ovarian and endo ca?
|
1.5 - 4%
30% with endometriod adenoca of ovary will have assoc endometrial ca Granulosa cell - 15-20% assoc endo ca |
|
|
Who would you treat with primary radiation for endoCA? What benchmark is useful to decide whether to order srugery?
|
women who have medical comorbidities limiting them from surgery. Operative risk should be greater than 10-15% lifetime risk of recurrence with radiation alone.
|
|
|
Incidence of pos nodes in:
Grade 1,2,3 1a,1b,1c |
Grade:3, 9,18 percent
Stage 1a-1c: less than 5 percent (1a,1b) and 20 percent w 1c. |
|
|
Does lymphadenectomy impact survival in em ca?
|
Not in stage 1 or 2, but yes w st1gr3
Yes In 1bgr3 and higher |
|
|
What are some significant independent prognostic factors for em ca?
|
Lvsi, tumor size, grade
|
|
|
What are criteria for needing adjuvant radiation?
|
Grade 2/3, outer 1/3 myom inv, Lvsi.
If ynger than 50, need 3 risk factors 50-70: 2 risk factors Over 70: 1 risk factor |
|
|
Follow up for em ca?
Can u give hrt? |
Fu: q3-4mos x 2 yrs then q6mos. Vaginal pap qvisit (tho low yield).
ACOG says hrt ok, pt needs to be willing to assume risk. |
