Devita, Hellman, and Rosenberg's Cancer

LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10

320 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 23.2.26.This patient’s records arrive in the office, and the pathology verifies the

diagnosis of a grade 2 endometrioid-type endometrial cancer from an

office endometrial biopsy. She asks what has caused her cancer to develop.

You tell her all of the following are considered to be independent risk

factors for the development of endometrial cancer, EXCEPT:

A. Obesity

B. Diabetes mellitus

C. Premature ovarian failure with early menopause

D. Presence of an estrogen-producing tumor

Question 23.2.27.For this patient with an office biopsy demonstrating grade 2 endometrioid

endometrial cancer who is of apparent good heath with no other medical

comorbidities, you recommend:

A. Further evaluation with CT scan and PET scan to evaluate for

metastatic disease

B. A formal dilation and curettage (D&C) to obtain a more accurate

pathologic diagnosis

C. Hysterectomy with removal of the tubes and ovaries with considera-

tion of pelvic and para-aortic lymphadenectomy

D. Referral for radiation therapy with possible chemoradiation

Question 23.2.28.During the patient’s initial visit, she reports her mother was diagnosed

with endometrial cancer at age 42 years, her maternal aunt with colon

cancer at age 51 years, and her sister with endometrial cancer at age 38

years. You are concerned her cancer may be hereditary. You advise that:

A. She undergo colon assessment if she is not up to date with age-

appropriate screening and consider counseling and possible testing

for hereditary nonpolyposis colorectal cancer (Lynch II syndrome).

B. She undergo breast MRI and be tested for BRCA1 and BRCA2.

C. Colon and endometrial cancers are common, and no further evalua-

tion is necessary at this time.

D. The maternal side of her family very likely has familial adenomatous

polyposis and should be further evaluated.

Question 23.2.29.The patient undergoes hysterectomy with full staging, including pelvic

washing for cytology, removal of both tubes and ovaries; pelvic and para-

aortic lymph nodes are removed. She is noted to have cancer involving

three pelvic lymph nodes. Her stage is designated:

A. IC

B. IIC

C. IIIC

D. IVA