cancer survivorship
DESCRIPTION
Cancer Survivorship. Endometrial Cancer Risks and Treatments: Epidemiology and Late Effects of Cancer Survival. All images in this module were obtained from Berek, JS, Hacker, NF: Practical Gynecologic Oncology, 2 nd Ed, 1994. Goal of this Module. - PowerPoint PPT PresentationTRANSCRIPT
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2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant.
Cancer Survivorship
Endometrial Cancer Risks and Treatments: Epidemiology and Late Effects
of Cancer Survival
All images in this module were obtained from Berek, JS, Hacker, NF: Practical Gynecologic Oncology, 2nd Ed, 1994.
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Goal of this Module
This is an interactive and self-directed learning module intended to build a foundation of knowledge around the epidemiology and late effects of cancer survival. This is one of several educational modules you will complete during your core clinical clerkships. Themes emphasized in this, and other modules, are:
Epidemiology of survival Late effects Psychosocial concerns Secondary prevention Strategies for behavior change
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Case #1
Ms. Johnson, an obese, 64 year-old, Caucasian woman, gravida 1, para 1, comes to see you because she is having post menopausal bleeding over the past month (Causes of post menopausal bleeding). She has no other symptoms. She has not been receiving hormone replacement therapy with estrogen or progesterone.
Next
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Question #1
Of the following risk factors for developing endometrial cancer, which are the most significant in the patient’s history:
A. Amount of vaginal bleedingB. ObesityC. Patient ageD. Number of pregnancies
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Incorrect. Question #1
A. Amount of vaginal bleeding The amount of vaginal bleeding per se is not a risk
factor for the development of endometrial cancer. More important is the relationship of the bleeding to the menopausal status. Even relatively modest amount of bleeding in women who are many years post-menopausal is associated with a very high rate endometrial cancer. Very heavy and irregular menses over many years in pre-menopausal women can be associated with endometrial hyperplasia which is a precursor for endometrial cancer.
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Correct. Question #1
B. Obesity Women who are overweight get endometrial
cancer twice as often as do women who are not overweight. Excessive weight can put a woman at the highest relative risk of developing endometrial cancer. Most young women who get the disease are obese, although it is unusual to get endometrial cancer under the age of 45.
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Go toRelative Risk
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Incorrect. Question #1
C. Patient Age Patient age is an important risk factor because
most women who get endometrial cancer are post-menopausal. However, the relative risk associated with age is not as great as one other variable.
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Incorrect. Question #1
D. Number of Pregnancies Although women who have never been pregnant
have a higher chance of developing endometrial cancer, it is not the variable with the highest risk. It is thought that pregnancy protects against endometrial cancer because ovulation is suppressed.
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Question #2
Had this patient been taking oral post menopausal estrogen therapy she would be at higher risk of developing endometrial cancer. There is an indisputable link between “unopposed” estrogen therapy and the risk of developing endometrial cancer. Of the following variables of estrogen usage, which has the significant impact of that risk?
A. Types of hormone
B. Dose of hormone
C. Duration of use (years)
D. Age of initiation of therapy
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Incorrect. Question #2
A. Types of Hormone The type of estrogen and progesterone is not as
important as whether or not the woman is taking estrogen without progesterone to protect the endometrium.
Risk is mediated through states that lead to an excess of estrogen over progesterone.
Using a combination of estrogen and progesterone decreases the risk linked to the use of estrogen alone.
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Incorrect. Question #2
B. Dose of hormone Increase in estrogen dose increases the risk of
endometrial cancer, but decrease exposure to estrogens or increase progesterone levels tend to be protective.
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Correct. Question #2
C. Duration of use (years) Increase in duration of use increases the risk of
endometrial cancer. The longer the use of estrogen in the absence of progesterone, the higher the probability of developing endometrial cancer.
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Incorrect. Question #2
D. Age of initiation of therapy Most women initiate therapy when they become
menopausal. The age of initiation of therapy is not particularly relevant compared with the duration of use of hormone therapy.
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Case #1 Continued
On physical exam, the patient is noted to weigh 232 lbs and her height is 5’5”. On pelvic exam it is difficult to assess the size of her uterus, however it appears to be slightly enlarged. You perform an endometrial biopsy and submit it for pathological evaluation.
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Question #3
Based on this scenario, the most likely histology is:
A. Clear cell
B. Endometrioid
C. Papillary Serous
D. Mixed histology
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Incorrect. Question #3
A. Clear Cell The lesions of clear cell carcinoma are similar
to those seen in the ovary. An association with DES has not been demonstrated with the endometrial lesion. The lesions are uncommon, accounting for 2-3% of all adenocarcinomas of the endometrium and tend to have a poor prognosis.
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Correct. Question #3
B. Endometrioid (See image) This is the most common type of endometrial
cancer (See table). It is called endometrioid because it looks like endometrial glands.
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Incorrect. Question #3
C. Papillary Serous Similar to a papillary serous lesion of the ovary.
The complex papillae are lined with cuboidal or low columnar cells with severe nuclear anaplasia, prominent nucleoli, and high mitotic activity (See microscopic image). An aggressive behavior with peritoneal spread can occur with minimal myometrial invasion, presumably through transtubal spread (See hysterectomy specimen).
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Incorrect. Question #3
D. Mixed histology One can have combinations of endometrioid,
clear cell, and papillary serous carcinomas, but these are less common.
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Case #1 Continued
The results of the biopsy showed an endometrioid adenocarcinoma, moderately differentiated (grade 2). Based on this result, you recommend that the patient have surgery.
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Question #4
The recommended surgery for this condition is exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH & BSO) and:
A. No other biopsiesB. Pelvic lymphadenectomyC. Para-aortic lymphadenectomyD. Pelvic and para-aortic lymphadenectomy
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Incorrect. Question #4
A. No other biopsies A “staging” laparotomy must be perform in
order to determine the true extensive disease even if there is a preoperative scan showing a uterine tumor. The FIGO staging requires a surgical procedure. The staging laparotomy typically includes the performance of peritoneal cytology and biopsies including lymph node biopsies.
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Incorrect. Question #4
B. Pelvic lymphadenectomy In most circumstances in order to do a thorough
staging operation a paraortic lymphadenectomy must be performed. This is important because patients with metastatic disease to the paraortic lymph nodes require additional therapy.
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Incorrect. Question #4
C. Para-aortic lymphadenectomy While it is important to perform a para-aortic
lymphadenectomy, a pelvic lymphadenectomy is also included in the staging laparotomy.
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Correct. Question #4
D. Pelvic and para-aortic lymphadenectomy In order to perform a thorough surgical staging
for endometrial cancer, both pelvic and para-aortic lymphadenectomy should be performed unless there is a medical contraindication, e.g., morbid obesity or severe cardiovascular disease.
Continue Module
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Case #1 Continued
Patient undergoes a hysterectomy and staging. The tumor is grade 2 and invades one half of the muscle wall. There are no metastasis to the pelvic or para-aortic lymph nodes.
Next
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Question #5
Based on these findings, her stage is:
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
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Correct. Question #5
A. Stage I The patient’s disease is confined to the uterus (
See image) and there is no evidence of metastatic disease (FIGO Stage I).
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Incorrect. Question #5
B. Stage II Stage II disease means the tumor has extended
from the endometrium to the cervix (FIGO Stage II).
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Incorrect. Question #5
C. Stage III FIGO Stage III means the disease has spread to
the pelvic or para-aortic lymph nodes.
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Incorrect. Question #5
D. Stage IV FIGO Stage IV means the disease has
metatasized to distant organs. e.g., the liver or the lung parenchyma (See X-ray image).
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Case #1 Continued
Based on these finding this patient was recommended and received pelvic radiation therapy.
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Question #6
Based on her stage and treatment, the probability of her five-year disease-free survival:
A. 85%B. 70%C. 50%D. 30%
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Correct. Question #6
A. 85% Patient with Stage IB, grade 2 has
approximately 85%, 5 yr survival based on surgical staging. Within Stage IB, the prognosis depends on additional variables (See table).
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Incorrect. Question #6
B. 70% Patient with Stage IB, grade 2 tumor and has a
better 5 year survival based on surgical staging.
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Incorrect. Question #6
C. 50% Patient with Stage IB, grade 2 tumor and has a
better 5 year survival based on surgical staging.
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Incorrect. Question #6
D. 30%• Patient with Stage IB, grade 2 tumor and has a
better 5 year survival based on surgical staging.
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Question #7
In women with endometrial cancer, the likelihood of cure is lower in African-American women compared with Caucasian women in the U.S. What is the difference in survival at 5 years?
A. 5%B. 10%C. 15%D. 25%
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Incorrect. Question #7
A. 5% Unfortunately, there is an even greater disparity
in 5 year survival rates between African American and Caucasian women in the United States.
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Incorrect. Question #7
B. 10% Unfortunately, there is an even greater disparity
in 5 year survival rates between African American and Caucasian women in the United States.
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Incorrect. Question #7
C. 15% Unfortunately, there is an even greater disparity
in 5 year survival rates between African American and Caucasian women in the United States.
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Correct. Question #7
D. 25% Unfortunately, there is this large disparity in 5
year survival rates between African American and Caucasian women in the United States.
NextQuestion
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Question #8
The treatment of endometrial cancer has an impact on subsequent sexual functioning. The most significant decrease in the frequency of the sexual activity is found after which of the following treatments for stage I disease?
A. HysterectomyB. Radiation therapyC. Hysterectomy plus radiation therapyD. Chemotherapy
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Incorrect. Question #8
A. Hysterectomy In women who undergo a hysterectomy for this disease
and do not require adjuvant treatment, there should be no significant impact on sexual function. However, in women who are premenopausal who require removal of their ovaries, the lower levels of estrogen may be associated with changes in sexual function.
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Incorrect. Question #8
B. Radiation therapy Radiation therapy can produce vaginal changes that can
make intercourse more difficult and in some cases painful, adjuvant radiation is generally used after the performance of a hysterectomy.
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Correct. Question #8
C. Hysterectomy plus radiation therapy In some women who receive adjuvant radiation
therapy after hysterectomy, intercourse becomes more difficult or even painful because of the development of radiation vaginitis or stenosis.
NextQuestion
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Incorrect. Question #8
D. Chemotherapy Most patients who receive adjuvant treatment for
endometrial cancer after hysterectomy require radiation therapy. While chemotherapy is occasionally used in selected patients with certain types of histologies, (clear cell or papillary serous carcinoma), this usually does not interfere with long term sexual function.
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Question #9
Following the treatment of stage I endometrial cancer with a hysterectomy in an obese woman, the patient should be counseled to lose weight, because obesity increase the subsequent risk of:
A. Recurrent endometrial cancerB. Cervical cancerC. Breast cancerD. Colon cancer
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Incorrect. Question #9
A. Recurrent endometrial cancer There is no evidence that obesity increases the
rate of recurrence of endometrial cancer. Obesity does predispose the development of endometrial cancer, however.
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Incorrect. Question #9
B. Cervical cancer Patients who have been treated for endometrial
cancer should have undergone a complete hysterectomy, including the surgical removal of the cervix.
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Correct. Question #9
C. Breast cancer Even though this patient may have been treated
for her endometrial cancer, obesity still predisposes to the development of breast cancer.
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Incorrect. Question #9
D. Colon cancer Unless the patient falls into a family cancer
syndrome which predisposes to both the development of colon and endometrial cancer (HNPCC syndrome), her risk of subsequent colon cancer is not increased.
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Question #10
Conservative treatment (use of hormonal therapy with preservation of the uterus) is used for selected young patients (<35 years of age) with well differentiated stage I endometrial cancer. Compared to a woman who does not have the disease, fertility in these women is significantly:
A. AbrogatedB. DecreasedC. UnchangedD. Increased
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Incorrect. Question #10
A. Abrogated If the uterus responds to hormonal treatment and is
preserved, it is still possible for these patients to become pregnant, although it often requires ovulation induction and timed insemination.
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Correct Question #10
B. Decreased Although these women retain the uterus and the
potential for fertility, their ability to conceive is considerably reduced compared to women who do not have this condition.
Complete Post Test
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Incorrect. Question #10
C. Unchanged These women retain the uterus and the potential for
fertility, however, their ability to conceive is different than women who do not have this condition.
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Incorrect. Question #10
D. Increased These women retain the uterus and the potential
for fertility, however, their ability to conceive is different than women who do not have this condition.
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Endometrial Cancer Risk Factors
Certain factors can make one woman more likely to get endometrial cancer than another. These are called risk factors. However, a woman who has one or more risk factors will not necessarily get endometrial cancer. In fact, a woman can have all the risk factors and still not get endometrial cancer, or she can have no known risk factors and still get the disease.
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What is Endometrial Cancer?
Endometrial cancer begins in the uterus, or womb. The uterus is part of the female reproductive system. It protects the growing fetus during pregnancy, and is involved in menstruation and menopause. The most common form of endometrial cancer develops in the lining of the uterus, which is known as the endometrium. Endometrial cancer is the most common cancer of the female reproductive system and is usually curable when detected early.
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Anatomy of the Uterus
Cross Section of the Female Reproductive System (Courtesy of Jones and Bartlett Publishers)
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The Female Reproductive System
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Relative Risk MatrixAge ( > 50 years) 1.5
Endometrial hyperplasia 2-10
Estrogen (unopposed) 2-6
Obesity 2-10
Other cancers (breast and ovary) 2-3
Pregnancy (nulligravida vs. gravida) .5-.75
Race (African American vs. Caucasian) 1.25
Tamoxifen 2-7
Irregular menstrual periods 1.1-1.5
Hypertension 1.1-1.5
Diabetes 1.1-1.5
Late menopause 1.25-1.5
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Age ( > 50 years) 1.5
Endometrial hyperplasia 2-10
Estrogen (unopposed) 2-6
Obesity 2-10
Other cancers (breast and ovary) 2-3
Pregnancy (nulligravida vs. gravida) .5-.75
Race (African American vs. Caucasian) 1.25
Tamoxifen 2-7
Irregular menstrual periods 1.1-1.5
Hypertension 1.1-1.5
Diabetes 1.1-1.5
Late menopause 1.25-1.5
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Continue Module
Relative Risk Matrix
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Endometrial Cancer Risk Factors
Age. Most women who get endometrial cancer are over age 50. A woman is at higher risk if she is post-menopausal and over age 50.
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Endometrial Cancer Risk Factors
Age. Most women who get endometrial cancer are over age 50. A woman is at higher risk if she is post-menopausal and over age 50.
Go toRelative Risk
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Endometrial Cancer Risk Factors
Age. Most women who get endometrial cancer are over age 50. A woman is at higher risk if she is post-menopausal and over age 50.
Go toRelative Risk
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Endometrial Cancer Risk Factors
Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.
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Endometrial Cancer Risk Factors
Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.
Go toRelative Risk
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Endometrial Cancer Risk Factors
Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.
Go toRelative Risk
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Estrogen (unopposed). Women who use estrogen replacement therapy without progesterone have a higher chance of developing endometrial cancer. If a woman needs estrogen replacement therapy, she should discuss using a combination of estrogen and progesterone with her doctor. This protects the uterus from developing cancer.
Endometrial Cancer Risk Factors
Go toRelative Risk
![Page 71: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/71.jpg)
Estrogen (unopposed). Women who use estrogen replacement therapy without progesterone have a higher chance of developing endometrial cancer. If a woman needs estrogen replacement therapy, she should discuss using a combination of estrogen and progesterone with her doctor. This protects the uterus from developing cancer.
Endometrial Cancer Risk Factors
Go toRelative Risk
![Page 72: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/72.jpg)
Endometrial Cancer Risk Factors
Obesity. Women who are overweight get endometrial cancer twice as often as do women who are not overweight. Excessive weight can put a woman at the highest risk of developing endometrial cancer. Most young women who get the disease are obese, although it is unusual to get endometrial cancer under the age of 45. The relative risk of endometrial cancer in obese women is 2-7.
Go toRelative Risk
Back toExplanation
![Page 73: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/73.jpg)
Endometrial Cancer Risk Factors
Obesity. Women who are overweight get endometrial cancer twice as often as do women who are not overweight. Excessive weight can put a woman at the highest risk of developing endometrial cancer. Most young women who get the disease are obese, although it is unusual to get endometrial cancer under the age of 45. The relative risk of endometrial cancer in obese women is 2-7.
Go toRelative Risk
![Page 74: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/74.jpg)
Endometrial Cancer Risk Factors
Obesity. Women who are overweight get endometrial cancer twice as often as do women who are not overweight. Excessive weight can put a woman at the highest risk of developing endometrial cancer. Most young women who get the disease are obese, although it is unusual to get endometrial cancer under the age of 45. The relative risk of endometrial cancer in obese women is 2-7.
Go toRelative Risk
![Page 75: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/75.jpg)
Endometrial Cancer Risk Factors
Other cancers. Women who have had colon, rectal, or breast cancer have a higher chance of developing endometrial cancer
Go toRelative Risk
![Page 76: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/76.jpg)
Endometrial Cancer Risk Factors
Other cancers. Women who have had colon, rectal, or breast cancer have a higher chance of developing endometrial cancer
Go toRelative Risk
![Page 77: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/77.jpg)
Endometrial Cancer Risk Factors
Pregnancy. Women who have never been pregnant have a higher chance of developing endometrial cancer. It is thought that pregnancy protects against endometrial cancer because high levels of progestins are produced during pregnancy.
Go toRelative Risk
Back toExplanation
![Page 78: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/78.jpg)
Endometrial Cancer Risk Factors
Pregnancy. Women who have never been pregnant have a higher chance of developing endometrial cancer. It is thought that pregnancy protects against endometrial cancer because high levels of progestins are produced during pregnancy.
Go toRelative Risk
![Page 79: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/79.jpg)
Endometrial Cancer Risk Factors
Pregnancy. Women who have never been pregnant have a higher chance of developing endometrial cancer. It is thought that pregnancy protects against endometrial cancer because high levels of progestins are produced during pregnancy.
Go toRelative Risk
![Page 80: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/80.jpg)
Endometrial Cancer Risk Factors
Race. Women who are white have a higher chance of developing endometrial cancer than do non-white women. For reasons that are not entirely clear, cancer is approximately twice as common in whites as it is in African-Americans and other non-whites.
Go toRelative Risk
![Page 81: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/81.jpg)
Endometrial Cancer Risk Factors
Race. Women who are white have a higher chance of developing endometrial cancer than do non-white women. For reasons that are not entirely clear, cancer is approximately twice as common in whites as it is in African-Americans and other non-whites.
Go toRelative Risk
![Page 82: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/82.jpg)
Endometrial Cancer Risk Factors
Tamoxifen. Tamoxifen is a drug that is sometimes used to treat women with breast cancer. Studies have found that some women who take tamoxifen for 5 years or more have a higher risk of developing endometrial cancer. However, while several studies have shown that tamoxifen can significantly increase a woman's risk of endometrial polyps and cancer, it is believed that its ability to lower the incidence of breast cancer deaths outweighs the risk of developing endometrial cancer. A woman who has been receiving tamoxifen, does not need routine x-rays or biopsies, but she should be examined by her gynecologist at least once a year or right away if irregular bleeding occurs.
Go toRelative Risk
![Page 83: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/83.jpg)
Endometrial Cancer Risk Factors
Tamoxifen. Tamoxifen is a drug that is sometimes used to treat women with breast cancer. Studies have found that some women who take tamoxifen for 5 years or more have a higher risk of developing endometrial cancer. However, while several studies have shown that tamoxifen can significantly increase a woman's risk of endometrial polyps and cancer, it is believed that its ability to lower the incidence of breast cancer deaths outweighs the risk of developing endometrial cancer. A woman who has been receiving tamoxifen, does not need routine x-rays or biopsies, but she should be examined by her gynecologist at least once a year or right away if irregular bleeding occurs.
Go toRelative Risk
![Page 84: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/84.jpg)
Endometrial Cancer Risk Factors
Irregular menstrual periods. Some women may not ovulate regularly during the reproductive years. This can upset the delicate balance between estrogenic hormones that encourage the development of cancer and the progestigenic hormones that protect against cancer.
Go toRelative Risk
Back toExplanation
![Page 85: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/85.jpg)
Endometrial Cancer Risk Factors
Irregular menstrual periods. Some women may not ovulate regularly during the reproductive years. This can upset the delicate balance between estrogenic hormones that encourage the development of cancer and the progestigenic hormones that protect against cancer.
Back to Question #4
![Page 86: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/86.jpg)
Endometrial Cancer Risk Factors
Irregular menstrual periods. Some women may not ovulate regularly during the reproductive years. This can upset the delicate balance between estrogenic hormones that encourage the development of cancer and the progestigenic hormones that protect against cancer.
Go toRelative Risk
![Page 87: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/87.jpg)
Endometrial Cancer Risk Factors
Hypertension. Hypertension (high blood pressure) has been associated with endometrial cancer, but not as strongly as some of the other risk factors.
Go toRelative Risk
![Page 88: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/88.jpg)
Endometrial Cancer Risk Factors
Hypertension. Hypertension (high blood pressure) has been associated with endometrial cancer, but not as strongly as some of the other risk factors.
Go toRelative Risk
![Page 89: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/89.jpg)
Endometrial Cancer Risk Factors
Diabetes. Women with diabetes have twice the risk of endometrial cancer as women who do not have diabetes. Similar to hypertension, many women with diabetes are also overweight. It is not entirely clear how much of the increased risk in women with diabetes is due to the diabetic condition as opposed to being overweight.
Go toRelative Risk
![Page 90: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/90.jpg)
Endometrial Cancer Risk Factors
Diabetes. Women with diabetes have twice the risk of endometrial cancer as women who do not have diabetes. Similar to hypertension, many women with diabetes are also overweight. It is not entirely clear how much of the increased risk in women with diabetes is due to the diabetic condition as opposed to being overweight.
Go toRelative Risk
![Page 91: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/91.jpg)
Endometrial Cancer Risk Factors
Late menopause. Women who have a later menopause have a slightly increased risk of developing endometrial cancer
Go toRelative Risk
![Page 92: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/92.jpg)
Endometrial Cancer Risk Factors
Late menopause. Women who have a later menopause have a slightly increased risk of developing endometrial cancer
Go toRelative Risk
![Page 93: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/93.jpg)
Relative Risk MatrixAge ( > 50 years) 1.5
Endometrial hyperplasia 2-10
Estrogen (unopposed) 2-6
Obesity 2-10
Other cancers (breast and ovary) 2-3
Pregnancy (nulligravida vs. gravida) .5-.75
Race (African American vs. Caucasian) 1.25
Tamoxifen 2-7
Irregular menstrual periods 1.1-1.5
Hypertension 1.1-1.5
Diabetes 1.1-1.5
Late menopause 1.25-1.5
Go to Question 2
![Page 94: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/94.jpg)
Endometrial Cancer Risk Factors
Age. Most women who get endometrial cancer are over age 50. A woman is at higher risk if she is post-menopausal and over age 50.
Go toRelative Risk
![Page 95: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/95.jpg)
Endometrial Cancer Risk Factors
Endometrial hyperplasia. Women who have endometrial hyperplasia have a higher risk of developing endometrial cancer.
Go toRelative Risk
![Page 96: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/96.jpg)
Estrogen (unopposed). Women who use estrogen replacement therapy without progesterone have a higher chance of developing endometrial cancer. If a woman needs estrogen replacement therapy, she should discuss using a combination of estrogen and progesterone with her doctor. This protects the uterus from developing cancer.
Endometrial Cancer Risk Factors
Back toQuestion 2
Go toRelative Risk
![Page 97: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/97.jpg)
Estrogen (unopposed). Women who use estrogen replacement therapy without progesterone have a higher chance of developing endometrial cancer. If a woman needs estrogen replacement therapy, she should discuss using a combination of estrogen and progesterone with her doctor. This protects the uterus from developing cancer.
Endometrial Cancer Risk Factors
Go toRelative Risk
![Page 98: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/98.jpg)
Endometrial Cancer Risk Factors
Obesity. Women who are overweight get endometrial cancer twice as often as do women who are not overweight. Excessive weight can put a woman at the highest risk of developing endometrial cancer. Most young women who get the disease are obese, although it is unusual to get endometrial cancer under the age of 45. The relative risk of endometrial cancer in obese women is 2-7.
Go toRelative Risk
![Page 99: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/99.jpg)
Endometrial Cancer Risk Factors
Other cancers. Women who have had colon, rectal, or breast cancer have a higher chance of developing endometrial cancer
Go toRelative Risk
![Page 100: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/100.jpg)
Endometrial Cancer Risk Factors
Pregnancy. Women who have never been pregnant have a higher chance of developing endometrial cancer. It is thought that pregnancy protects against endometrial cancer because high levels of progestins are produced during pregnancy.
Go toRelative Risk
![Page 101: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/101.jpg)
Endometrial Cancer Risk Factors
Race. Women who are white have a higher chance of developing endometrial cancer than do non-white women. For reasons that are not entirely clear, cancer is approximately twice as common in whites as it is in African-Americans and other non-whites.
Go toRelative Risk
![Page 102: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/102.jpg)
Endometrial Cancer Risk Factors
Tamoxifen. Tamoxifen is a drug that is sometimes used to treat women with breast cancer. Studies have found that some women who take tamoxifen for 5 years or more have a higher risk of developing endometrial cancer. However, while several studies have shown that tamoxifen can significantly increase a woman's risk of endometrial polyps and cancer, it is believed that its ability to lower the incidence of breast cancer deaths outweighs the risk of developing endometrial cancer. A woman who has been receiving tamoxifen, does not need routine x-rays or biopsies, but she should be examined by her gynecologist at least once a year or right away if irregular bleeding occurs.
Go toRelative Risk
![Page 103: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/103.jpg)
Endometrial Cancer Risk Factors
Irregular menstrual periods. Some women may not ovulate regularly during the reproductive years. This can upset the delicate balance between estrogenic hormones that encourage the development of cancer and the progestigenic hormones that protect against cancer.
Go toRelative Risk
![Page 104: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/104.jpg)
Endometrial Cancer Risk Factors
Hypertension. Hypertension (high blood pressure) has been associated with endometrial cancer, but not as strongly as some of the other risk factors.
Go toRelative Risk
![Page 105: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/105.jpg)
Endometrial Cancer Risk Factors
Diabetes. Women with diabetes have twice the risk of endometrial cancer as women who do not have diabetes. Similar to hypertension, many women with diabetes are also overweight. It is not entirely clear how much of the increased risk in women with diabetes is due to the diabetic condition as opposed to being overweight.
Go toRelative Risk
![Page 106: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/106.jpg)
Endometrial Cancer Risk Factors
Late menopause. Women who have a later menopause have a slightly increased risk of developing endometrial cancer
Go toRelative Risk
![Page 107: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/107.jpg)
Causes of Postmenopausal bleeding
Back toCase 1
![Page 108: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/108.jpg)
Endometrial Hyperplasia
Back toExplanation
![Page 109: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/109.jpg)
Endometrial Hyperplasia
Back toExplanation
![Page 110: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/110.jpg)
Endometrial Hyperplasia
Back toExplanation
![Page 111: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/111.jpg)
Histology Table
Subtype Alive (%) DOD (%)
Adenoacanthoma 87.5 6.3
Adenocarcinoma 79.8 6.2
Papillary serous 69.7 21.2
Adenosquamous 53.1 32.7
Clear cell 44.2 51.2
Sarcoma 31.2 64.3
Back toExplanation
![Page 112: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/112.jpg)
Uterus
Back toExplanation
![Page 113: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/113.jpg)
Tamoxifen
Back toExplanation
![Page 114: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/114.jpg)
Tamoxifen
Back toExplanation
![Page 115: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/115.jpg)
Tamoxifen
Back toExplanation
![Page 116: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/116.jpg)
Clear Cell
Back toExplanation
![Page 117: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/117.jpg)
Clear Cell
Back toExplanation
![Page 118: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/118.jpg)
Endometrioid
Back toExplanation
![Page 119: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/119.jpg)
Normal vs. Abnormal Uterine
Normal Uterus Endometrial CABack to
Explanation
![Page 120: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/120.jpg)
Papillary Serous Carcinoma
Back toExplanation
![Page 121: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/121.jpg)
Papillary Serous Carcinoma
Back toExplanation
![Page 122: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/122.jpg)
Lung X-ray
Back toExplanation
![Page 123: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/123.jpg)
Sarcoma
Back toHistology
Table
![Page 124: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/124.jpg)
Papillary Serous
Back toExplanation
![Page 125: Cancer Survivorship](https://reader031.vdocument.in/reader031/viewer/2022013004/5681420f550346895dae121b/html5/thumbnails/125.jpg)
Prognostic Variables
Back toExplanation
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Histologic Grade of Endometrioid Adenocarcinoma
Graded by the architecture alone (GOG) or a combination of architecture and nuclear features (FIGO and WHO): Well-differentiated (grade 1) lesions contain 98% or
more glandular or papillary formations. Moderately differentiated (grade 2) tumors have 2-50%
solid areas. Poorly differentiated (grade 3) neoplasms have more
than 50% solid areas.
Back to Case #1
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FIGO* Staging of Endometrial Cancer
Stage I: The cancer is only in the body of the uterus. Stage IA: The cancer is only in the endometrium. Stage IB: The cancer has spread less than halfway through the myometrium. Stage IC: The cancer has spread halfway through the myometrium. Stage II: The cancer has spread from the uterus to the cervix. Stage IIA: The cancer is in the body of the uterus and the endocervical glands. Stage IIB: The cancer is in the body of the uterus and the cervical stroma. Stage III: The cancer has spread outside the body of the uterus, but has not left the pelvic area. Stage IIIA: The cancer has spread to the serosa of the uterus, or the adnexa, or there are no
cancer cells in peritoneal fluid. Stage IIIB: The cancer has spread to the vagina. Stage IIIC: The cancer has spread to the lymph nodes near the uterus. Stage IV: The cancer has spread to the mucosa of the bladder or the rectum and/or has spread to
the lymph nodes in the groin, and/or has spread to other organs, such as the lungs or the bones. Stage IVA: The cancer has spread to the mucosa or inner lining of the rectum or bladder. Stage IVB: The cancer has spread to the lymph nodes in the groin area and/or has spread to other
organs, such as the lungs or bones.
*FIGO: International Federation of Obstetrics and Gynecology Back to Question 5
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FIGO* Staging of Endometrial Cancer
Stage I: The cancer is only in the body of the uterus. Stage IA: The cancer is only in the endometrium. Stage IB: The cancer has spread less than halfway through the myometrium. Stage IC: The cancer has spread halfway through the myometrium. Stage II: The cancer has spread from the uterus to the cervix. Stage IIA: The cancer is in the body of the uterus and the endocervical glands. Stage IIB: The cancer is in the body of the uterus and the cervical stroma. Stage III: The cancer has spread outside the body of the uterus, but has not left the pelvic area. Stage IIIA: The cancer has spread to the serosa of the uterus, or the adnexa, or there are no
cancer cells in peritoneal fluid. Stage IIIB: The cancer has spread to the vagina. Stage IIIC: The cancer has spread to the lymph nodes near the uterus. Stage IV: The cancer has spread to the mucosa of the bladder or the rectum and/or has spread to
the lymph nodes in the groin, and/or has spread to other organs, such as the lungs or the bones. Stage IVA: The cancer has spread to the mucosa or inner lining of the rectum or bladder. Stage IVB: The cancer has spread to the lymph nodes in the groin area and/or has spread to other
organs, such as the lungs or bones.
*FIGO: International Federation of Obstetrics and Gynecology NextQuestion
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Actuarial 5-year survival by Histologic Grade and Stage
Stage I Stage II
IA IB IC IIA IIBGrade % % % % %
1 92.3 94.1 83.2 86.1 72.7
2 89.7 84.9 79.8 71.8 71.1
3 81.5 76.3 68.3 65.9 49
Not Graded 85.9 84.8 68.8 80 59.6
Back to Explanation
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Actuarial 5-year survival by Histologic Grade and Stage
Stage I Stage II
IA IB IC IIA IIBGrade % % % % %
1 92.3 94.1 83.2 86.1 72.7
2 89.7 84.9 79.8 71.8 71.1
3 81.5 76.3 68.3 65.9 49
Not Graded 85.9 84.8 68.8 80 59.6
Back to Explanation
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Actuarial 5-year survival by Histologic Grade and Stage
Stage I Stage II
IA IB IC IIA IIBGrade % % % % %
1 92.3 94.1 83.2 86.1 72.7
2 89.7 84.9 79.8 71.8 71.1
3 81.5 76.3 68.3 65.9 49
Not Graded 85.9 84.8 68.8 80 59.6
Back to Explanation
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Actuarial 5-year survival by Histologic Grade and Stage
Stage I Stage II
IA IB IC IIA IIBGrade % % % % %
1 92.3 94.1 83.2 86.1 72.7
2 89.7 84.9 79.8 71.8 71.1
3 81.5 76.3 68.3 65.9 49
Not Graded 85.9 84.8 68.8 80 59.6
Back to Explanation
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Endometrial Cancer Genetics
The most common type of hereditary endometrial cancer syndrome is the Hereditary Non-Polyposis Colorectal Cancer (HNPCC or Lynch Syndrome II). In this syndrome, multiple family members can develop cancers arising from the colon, uterus, small intestine, kidney system, or the ovaries.
Back to Explanation
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Post Test
Please complete the post test included on this CD. Just click on the button below to access the post test. Turn in a completed post test and this CD to your clerkship director.
Post Test