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Old 03-21-2012
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Question Endometrial Cancer Prognosis!

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
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Ans ........C..........

stage = prognosis
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I'd say positive peritoneal washings. This will be seeding = distant metastases.
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C. Pelvic node metastasis
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i would say A :/
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I would go with A as well...the depth of invasion.
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Originally Posted by Hope2Pass View Post
I would go with A as well...the depth of invasion.
reason plz ?
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Old 03-21-2012
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Depth distinguishes in situ vs invasive, and hence prognosis.
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Originally Posted by tyagee View Post
reason plz ?
Well I THINK the question is stating that the patient has Cervical Intraepithelial Neoplasia (CIN) by showing a positive Pap Smear. For cells originating in the epithelium, the depth of invasion of the tumor directly relates to the prognosis of the tumor.

Normally the Staging criteria is a better prognostic factor.
Staging = TNM
T = size of the tumor,
N = spread to lymph nodes,
M = presence of metastatic dx

But in this case since its CIN, I would go with the depth of the invasion.
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The answer?
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pelvic nodes involvement..........
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Old 03-22-2012
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Both depth of invasion and Pelvic lymph node involvement are used in the FIGO staging of endometrial carcinoma, which defines the prognosis. I'll go with A though, since the pelvic nodes only define one stage
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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.
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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.
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
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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
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Quote:
Originally Posted by tyagee View Post
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?
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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.
seee 3 posts above for this one
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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
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?
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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."
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I found the same exact question in this forum and other forums !! With some same exact answers 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 ??
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A or C?
ANSWER PLEASE
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Quote:
Originally Posted by tyagee View Post
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
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?
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Quote:
Originally Posted by tyagee View Post
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?
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Quote:
Originally Posted by DocSikorski View Post
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?
HTML Code:
I mean, you are about to tell the pt - we can cut it out or sorry granny its too late...
i didnt get what u meant?



regarding source, its online qbank and its reliable...valid too ;-)
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HTML Code:
I mean, you are about to tell the pt - we can cut it out or sorry granny its too late...
i didnt get what u meant?



regarding source, its online qbank and its reliable...valid too ;-)
If its distant metastases as you and I were thinking while choosing "D", nobody would operate on that... So prognosis should be THE worst.

I do not think this is Usmle World question. Is it UsmleRx or ClinicalReview?
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Man i was so sure it was A
Fcuk my life.
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Man i was so sure it was A
Fcuk my life.
i was sure its D
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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 .......
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I don't know if this is a good question or a bad one. But I was sure the answer was either A or D. Never thought it would be B lol
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B is definitely wrong , grading has no significance , dont know which stupid Qs bank it is from , but can be misleading ..........

Its always stage ...... can be A , C or D ...... but never B .......
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Thumbs Down 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.
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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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