134
2004, David Geffen School of Medicine 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.

2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Embed Size (px)

Citation preview

Page 1: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Page 2: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 3: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 4: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 5: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 1

Page 6: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Continue Module

Go toRelative Risk

Page 7: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 1

Page 8: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 1

Page 9: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 10: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 2

Page 11: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 2

Page 12: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Continue Module

Page 13: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 2

Page 14: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Next

Page 15: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Question #3

Based on this scenario, the most likely histology is:

A. Clear cell

B. Endometrioid

C. Papillary Serous

D. Mixed histology

Page 16: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 3

Page 17: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Continue Module

Page 18: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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).

Back toQuestion 3

Page 19: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #3

D. Mixed histology One can have combinations of endometrioid,

clear cell, and papillary serous carcinomas, but these are less common.

Back toQuestion 3

Page 20: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Next

Page 21: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 22: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 4

Page 23: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 4

Page 24: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 4

Page 25: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 26: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 27: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Question #5

Based on these findings, her stage is:

A. Stage I

B. Stage II

C. Stage III

D. Stage IV

Page 28: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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).

Continue Module

Page 29: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #5

B. Stage II Stage II disease means the tumor has extended

from the endometrium to the cervix (FIGO Stage II).

Back toQuestion 5

Page 30: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #5

C. Stage III FIGO Stage III means the disease has spread to

the pelvic or para-aortic lymph nodes.

Back toQuestion 5

Page 31: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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).

Back toQuestion 5

Page 32: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Case #1 Continued

Based on these finding this patient was recommended and received pelvic radiation therapy.

Page 33: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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%

Page 34: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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).

Next

Page 35: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #6

B. 70% Patient with Stage IB, grade 2 tumor and has a

better 5 year survival based on surgical staging.

Back toQuestion 6

Page 36: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #6

C. 50% Patient with Stage IB, grade 2 tumor and has a

better 5 year survival based on surgical staging.

Back toQuestion 6

Page 37: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Incorrect. Question #6

D. 30%• Patient with Stage IB, grade 2 tumor and has a

better 5 year survival based on surgical staging.

Back toQuestion 6

Page 38: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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%

Page 39: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 7

Page 40: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 7

Page 41: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 7

Page 42: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 43: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 44: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 8

Page 45: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 8

Page 46: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 47: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 8

Page 48: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 49: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 9

Page 50: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 9

Page 51: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

NextQuestion

Page 52: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 9

Page 53: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 54: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 10

Page 55: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 56: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 10

Page 57: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back toQuestion 10

Page 58: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back to Question 1

Page 59: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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.

Back to Question 1

Page 60: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Anatomy of the Uterus

Cross Section of the Female Reproductive System (Courtesy of Jones and Bartlett Publishers)

Back to Explanation

Page 61: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

The Female Reproductive System

Back to Explanation

Page 62: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Back to Question 1

Page 63: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Back to Question 1

Continue Module

Relative Risk Matrix

Page 64: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Back toExplanation

Page 65: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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 66: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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 67: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Cancer Risk Factors

Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.

Go toRelative Risk

Back toExplanation

Page 68: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Cancer Risk Factors

Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.

Go toRelative Risk

Page 69: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Cancer Risk Factors

Endometrial hyperplasia. Women who have endometrial hyperplasia (See image) have a higher risk of developing endometrial cancer.

Go toRelative Risk

Page 70: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Cancer Risk Factors

Endometrial hyperplasia. Women who have endometrial hyperplasia have a higher risk of developing endometrial cancer.

Go toRelative Risk

Page 96: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Causes of Postmenopausal bleeding

Back toCase 1

Page 108: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Hyperplasia

Back toExplanation

Page 109: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Hyperplasia

Back toExplanation

Page 110: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrial Hyperplasia

Back toExplanation

Page 111: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Uterus

Back toExplanation

Page 113: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Tamoxifen

Back toExplanation

Page 114: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Tamoxifen

Back toExplanation

Page 115: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Tamoxifen

Back toExplanation

Page 116: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Clear Cell

Back toExplanation

Page 117: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Clear Cell

Back toExplanation

Page 118: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Endometrioid

Back toExplanation

Page 119: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Normal vs. Abnormal Uterine

Normal Uterus Endometrial CABack to

Explanation

Page 120: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Papillary Serous Carcinoma

Back toExplanation

Page 121: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Papillary Serous Carcinoma

Back toExplanation

Page 122: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Lung X-ray

Back toExplanation

Page 123: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Sarcoma

Back toHistology

Table

Page 124: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Papillary Serous

Back toExplanation

Page 125: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

Prognostic Variables

Back toExplanation

Page 126: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 127: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 128: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 129: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 130: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 131: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 132: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 133: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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

Page 134: 2004, David Geffen School of Medicine at UCLA. Cancer Survivorship Grant. Cancer Survivorship Endometrial Cancer Risks and Treatments: Epidemiology and

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