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57 Cards in this Set
- Front
- Back
most common gynecologic malignancy
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endometrial cancer
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Stage I survival for endometrial cancer
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95%
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Stage II/III survival for endometrial cancer
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25%
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Risk factors for endometrial cancer
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Obesity
Nulliparity Unopposed estrogen (PCOS) Tamoxifen use (weak estrogen) Diabetes Hypertension Atypical Endometrial Hyperplasia Family history |
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What are the two types of endometrial cancer?
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Type I : Estrogen related
Type II: Non estrogen-related |
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Characteristics of Type I Endometrial Cancer
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Estrogen-related
Disease of obesity Younger, perimenopausal women Heavier, associated with HTN and DM Low grade tumor, low risk for extra-uterine disease Generally early stage and surgically curable |
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Characteristics of Type II Endometrial Cancer
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Unrelated to estrogen
Older and thinner women African American High grade, high risk for extra-uterine disease; Aggressive |
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What genetic syndromes are associated with familial endometrial cancer?
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HNPCC: 60% lifetime risk of ovarian cancer (mismatch repair gene mutations)
(Lynch) |
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What are the routes of endometrial cancer spread?
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Transperitoneal seeding
Lymphatic Hematogenous: least common |
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Key anatomic finding: vessels are (lateral; medial) while ureter is (lateral; medial)
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lateral; medial
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What nodes should be assessed to determine if lymphatic spread of endometrial cancer has occurred?
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pelvic and para-aortic nodes
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What should be assessed to determine is transperitoneal seeding has occurred?
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peritoneal cytology and omentum
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What are the different histological subtypes of adenocarcinoma of the endometrium?
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Endometrioid: Most common
Mucinous Clear cell Papillary serous (UPSC) Carcinosarcoma or Mixed Malignant Mullerian: Very aggressive (included as adenocarcinoma rather than sarcoma) |
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What is the most common histological subtype of adenocarcinoma of the endometrium?
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Endometrioid
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Which of the histological subtypes of adenocarcinoma of the endometrium are considered to be high risk / aggressive ?
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Clear cell; Papillary serous; Carcinosarcoma or Mixed Malignant Mullerian
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What is the most common chief complaint that will lead to evaluation for endometrial cancer?
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vaginal bleeding
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How is dx of endometrial cancer made?
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By endometrial biopsy obtained either in the office or in the OR via D&C
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T/F A preoperative CT scan is needed for endometrial cancer surgery
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F
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How is endometrial cancer stage?
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Surgically.
Stage I: Confined to uterus Stage II: extension into cervix Stage III: extension to pelvis: cytology, tubes, ovaries, nodes Stage IV: distant disease, including omentum, lungs, upper abdomen |
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In addition to surgery, what is adjuvant therapy?
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Radiation
Chemo Sandwich therapy: radiation and chemo in sequence Hormonal therapy |
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What preop testing before endometrial cancer needs to be done?
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Chest xray
mammogram electrolytes CA-125 |
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What test performed at surgical workup correlates with depth of invasion, nodal spread, extra-uterine disease, and survival?
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CA-125
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T/F Radiation can be used as the primary treatment modality in extremely medically compromised patients BUT cure rates are lower
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T
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What is hormonal therapy?
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Advantage: Relatively non-toxic
Disadvantage: Never shown to be effective when used in the adjuvant setting Progestins: Response rate of 25% in recurrence |
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The majority of patients are diagnosed with early stage disease due to a recognizable presenting symptom-: ________
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vaginal bleeding
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T/F Surgery plus radiation and/or chemo is not performed if the patient has brain or lung mets in endometrial cancer.
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F
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leiomyoma are aka
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uterine fibroids
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Incidence of leiomyoma in women over age 30
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20-30%
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What is the racial difference in leiomyoma
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More common in AA than Caucasian
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What is the cell type of origin of leiomyoma?
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Smooth muscle of myometrium
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What is involved in the growth of leiomyoma?
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Many respond to estrogen; leiomyoma found almost exclusively during reproductive years
Other hormones, like GH, hPL, Progesterone, other growth factors |
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How are leiomyomas classified?
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Based on location: intramural, subserosal, submucosal, intraligamentous, parasitic
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T/F Leiomyomas can progress to leiomyosarcomas
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F. They arise de novo as benign or malignant, they don't transform to malignant.
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Sx and clinical presentation of leiomyoma
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1) Abnormal uterine bleeding
2) Infertility 3) Recurrent pregnancy loss 4) Pain 5) Sx of pelvic "pressure" |
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How are leiomyomas diagnosed?
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Pelvic exam
Imaging Hysteroscopy |
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What are indications for leiomyoma treatment?
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1) Symptoms: pain, ureteral obstruction, AUB, fertility considerations
2) Size: large ones above "comfort level" 3) Location - less impt now 4) Growth - if growth is rapid, or any growth in postmenopausal woman, concern that it's really a leiomyosarcoma Any coexisting |
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Tx of leiomyoma: medical
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1) Prostaglandin synthetase inhibitors
2) Progesterone therapy 3) GnRH agonists |
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Tx of leiomyoma: surgical
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1) Hysteroscopy
2) Myomectomy 3) Hysterectomy |
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What is uterine artery embolization a treatment for?
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Leiomyoma. It results in symptom improvement in up to 90%.
Leads to a reduction in myoma volume 35-50%. |
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Uterine artery embolization is more useful in (pre, post) menopausal women.
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Pre
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Endometrial hyperplasia: what is "simple" hyperplasia?
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Endometrium with dilated glands, some outpouching, abundant stroma that's a variant of cystic hyperplasia
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Endometrial hyperplasia: what is "complex" hyperplasia?
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Glands are crowded with little stroma, complex gland pattern and outpouching formation; back to back glands; architectural but not cytologic atypia.
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Endometrial hyperplasia: what is "atypical hyperplasia?"
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there is <b>cytologic atypia</b>, with increased nuclear:cytoplasm ratio. There is irregularity in size/shape of nuclei. Precursor to adenocarcinoma in situ.
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What is pathophysiology of endometrial hyperplasia?
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There is chronic unopposed estrogen stimulation (anovulation or estrogen repalcement therapy) and the endometrium undergoes profression from proliferative to hyperplastic with eventual progression to carcinoma if untreated.
(Approx 30% of endometrial carcinoma occurs this way) |
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What are risk factors for endometrial hyperplasia?
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1) Obesity
2) Anovulation 3) Exogenous estrogen 4) Estrogen producing tumors 5) Tamoxifen therapy 6) Epidemiology: nullipara, late menopause, HTN, diabetes, age between 50-60 |
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Postmenopausal bleeding: ____% have endometrial carcinoma
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10-20
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How will patient with endometrial hyperplasia present?
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Abnormal uterine bleeding
OR Postmenopausal bleeding |
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Mgmt of Simple hyperplasia or complex hyperplasia WITHOUT atypia
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Cyclic progestins
Resample endometrium 3-6 months LNG IUD |
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Mgmt of complex hyperplasia with atypia
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Should be considered pre-malignant.
Treat with hysterectomy OR progestin therapy if there are fertility concerns. |
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What are endometrial polyps?
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Polypoid projections into endometrial cavity
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What is the clinical presentation of endometrial polyps?
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Abnormal Uterine Bleeding: usually perimenstrual spotting
Account for up to 25% of postmenopausal bleeding. Most common in 5th decade of life. |
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How are endometrial polyps dxed?
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Hysteroscopy is best.
Endometrial sampling is NOT reliable. If prolapsed thru cervix, can be diagnosed that way. |
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Endometrial polyps: Tx
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Removal of polyp: use hysteroscopy and resection
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Which type of leiomyoma is most likely to be associated with abnormal bleeding?
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submucosal myomas
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T/F Each leiomyoma arises from multiple cells
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F. Single cell
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indications for tx of myomas
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pain
persistent abnormal bleeding rapid enlargement repetitive spontaneous abortion or infertility in absence of other expalanation |
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Endometrial polyps account for _____% of postmenopausal bleeding
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25
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