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Endometrial Cancer Prognosis!

4K views 31 replies 10 participants last post by  Hitman 
#1 ·
A 60-year-old nulliparous woman is seen by her gynecologist for a followup appointment to discuss the results of an endometrial biopsy performed after a routine Papanicolaou (PAP) smear showed high-grade atypia. Pathology reports the endometrial sample is positive for carcinoma. What is the single most important factor in establishing the patient's prognosis?

A. Depth of invasion
B. Histologic grade
C. Pelvic node metastasis
D. Positive peritoneal washings
E. Tumor volume
 
#13 ·
B is the answer @DocSikorski
Although the presence of positive peritoneal washings was previously an indicator of T3a disease, as of the most recent 2010 modification of the FIGO/TNM staging system, positive peritoneal cytology is no longer used to assign any T stage category.
 
#14 ·
Uhm, the question was about T stage?
I thought its about prognosis?

No matter how deep is the invasion, even if there is regional lymph node involvement - the general rule you can go on and excise it surgically. But if there is methastasis (M1) - thats it, chemo or radio or whatever - prognosis is poor
 
#15 ·
Prognosis is based on TNM Staging Classification, and in TNM the depth of invasion is the more important factor and not the pelvic node metastasis
 
#18 ·
I thought it goes in matter of propagation T -> N -> M

So to you answer can be A or B than...

I would keep my own answer of peritoneal washings as the possibility to methastasis (doesnt matter if there is an evidence of metastatic lesion anywhere or no - the spread has started...)

Where is this question from?
 
#16 ·
A 60-year-old nulliparous woman is seen by her gynecologist for a followup appointment to discuss the results of an endometrial biopsy performed after a routine Papanicolaou (PAP) smear showed high-grade atypia. Pathology reports the endometrial sample is positive for carcinoma. What is the single most important factor in establishing the patient's prognosis?

A. Depth of invasion
B. Histologic grade
C. Pelvic node metastasis
D. Positive peritoneal washings
E. Tumor volume
whats the answer?
 
#19 ·
http://www.hindawi.com/journals/ogi/2011/962518/
Outcome of Endometrial Cancer Stage IIIA with Adnexa or Serosal Involvement Only. Obstetrics and Gynecology International. Volume 2011:

"FIGO has recently updated the staging system with a significant change to the staging of endometrial carcinoma stage IIIA. The presence of abnormal cells in peritoneal washings no longer affects staging."
 
#20 ·
I found the same exact question in this forum and other forums !! With some same exact answers :rolleyes: non of them have the final answer !!! Every research in google has different suggestion as the most important prognosis !!! As I remember from Kaplan video doctor he was blowing that pathologist r the ones who could decide this specific thing !!! Ie the histologic grade !!! I remember goljan saying metastasis metastasis metastasis !!!!

Pleaaaaase what the final answer here ?? :rolleyes:
 
#22 ·
guys ans is B. histologic grade.
i thought it to be D because goljan said in audio to go for distant metz site for px as per TNM system.:(:(

here is the expln...
Option B (Histologic grade) is correct. There is an increased likelihood of extrauterine tumor spread with poorly differentiated tumor and thus substantially worsened prognosis.

Option A (Depth of invasion) is incorrect. Depth of invasion is the second most important prognostic factor. If the carcinoma has invaded more than one third of the myometrium, the prognosis becomes significantly worsened.

Option C (Pelvic node metastasis) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

Option D (Positive peritoneal washings) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

Option E (Tumor volume) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

can any1 give a strong reason why B is the ans.? i am not satisfied with ans.:(:(:( can we generalize prognosis concept to any cancer?
 
#23 ·
guys ans is B. histologic grade.
i thought it to be D because goljan said in audio to go for distant metz site for px as per TNM system.:(:(

here is the expln...
Option B (Histologic grade) is correct. There is an increased likelihood of extrauterine tumor spread with poorly differentiated tumor and thus substantially worsened prognosis.

Option A (Depth of invasion) is incorrect. Depth of invasion is the second most important prognostic factor. If the carcinoma has invaded more than one third of the myometrium, the prognosis becomes significantly worsened.

Option C (Pelvic node metastasis) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

Option D (Positive peritoneal washings) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

Option E (Tumor volume) is incorrect. Positive peritoneal washings, tumor volume, and pelvic node metastasis are all factors in prognosis, but are not as important as histologic grade and depth of invasion in determining survival rates.

can any1 give a strong reason why B is the ans.? i am not satisfied with ans.:(:(:( can we generalize prognosis concept to any cancer?
Maybe I am dumb, I am sorry, but isnt the question What is the single most important factor in establishing the patient's prognosis?

I mean, you are about to tell the pt - we can cut it out or sorry granny its too late...

Where is the question from?
 
#28 ·
This is crap ......... It has to be C or D .......

Depth of invasion , would not decide prognosis , i felt nodes or seeding are a stage ahead but was not sure which .........

and am still confused about it , gave a thought and felt it it could invade the near by structure like bladder , would become stage 4 inoperable , the nodes and seeding would have no value .... so confused more ....... :rolleyes::rolleyes:
 
#31 ·
The question is lame

I wont leave this question alone, ef no!

FA'12 page 251 Right in the middle of the page: Stage Usually Has More Prognostic Value Than Grade.

Imagine a guy from Australia comes to your office with like 25 melanomas on his body!
You tell him - Sir, you are just fine, good news: none of your melanomas seem to have invasive character, you are a healthy man, despite the fact that there are a dozen of metastases in your brain.
 
#32 ·
I wont leave this question alone, ef no!

FA'12 page 251 Right in the middle of the page: Stage Usually Has More Prognostic Value Than Grade.

Imagine a guy from Australia comes to your office with like 25 melanomas on his body!
You tell him - Sir, you are just fine, good news: none of your melanomas seem to have invasive character, you are a healthy man, despite the fact that there are a dozen of metastases in your brain.
:)):)):)):)):)):))
 
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