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Endometrial cancer

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High Yield Notes

13 pages

Flashcards

Endometrial cancer

of complete

Questions

USMLE® Step 1 style questions USMLE

of complete

A 65-year-old woman, gravida 2 para 2, presents to the office for evaluation of an abnormal routine Pap smear. She has been healthy and has no vaginal spotting or bleeding. The cervical cytology showed atypical glandular cells. Menarche was at age 14, and she had a regular menstrual cycle until menopause at the age of 47. Past medical history is significant for osteoporosis treated with raloxifene. She also took hormone replacement therapy for hot flashes for two years after menopause. Family history is significant for breast cancer in her mother. Vitals are within normal limits. BMI is 31.5 kg/m2. Pelvic examination shows loss of labial fullness and an atrophic vagina. Bimanual examination is significant for a small uterus. Endometrial sampling is performed, and histology shows complex papillary architecture with the presence of round calcific collections and marked nuclear atypia. Which of the following risk factors in this patient’s history is the most significant in the development of this patient’s condition?  

External References

First Aid

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Diabetes mellitus p. 350-358

endometrial cancer risk p. 658

Endometrial cancer

Lynch syndrome and p. 395

tamoxifen and p. 446

tumor suppressor genes and p. 220

Estrogen p. 648, 674

endometrial carcinoma p. 658

Hypertension p. 304

endometrial cancer p. 658

Lynch syndrome p. 395

endometrial cancer p. 658

Obesity

endometrial cancer p. 658

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Transcript

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Content Reviewers

Rishi Desai, MD, MPH,Yifan Xiao, MD

Endometrial carcinoma, or endometrial cancer, is when malignant or cancer cells arise in the glands of the endometrium, the lining of the uterus.

The uterus is a hollow organ that sits behind the urinary bladder and in front of the rectum.

The top of the uterus above the openings of the fallopian tubes is called the fundus, and the region below the openings is called the uterine body.

The uterus tapers down into the uterine isthmus and finally the cervix, which protrudes into the vagina.

Zooming into the cervix, there are two openings, a superior opening up top, and an inferior opening down below, both of which have mucus plugs to keep the uterus closed off except during menstruation and right before ovulation.

The uterus is anchored to the sacrum by utero-sacral ligaments, to the anterior body wall by round ligaments, and it’s supported laterally by cardinal ligaments as well as the mesometrium, which is part of the broad ligament.

The wall of the uterus has three layers: the perimetrium, which is a layer continuous with the lining of the peritoneal cavity, the myometrium, which is made of smooth muscle that contracts during childbirth to help push the baby out, and the endometrium, a mucosal layer, that undergoes monthly cyclic changes.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw Hill Professional (2019)
  5. "Adjuvant radiotherapy for stage I endometrial cancer" Cochrane Database of Systematic Reviews (2012)
  6. "Endometrial cancer" BMJ (2011)
  7. "Developmental Biology of Uterine Glands1" Biology of Reproduction (2001)
  8. "Diagnosis and Management of Endometrial Cancer" American family physician (2016)