LWBK1006-23 LWW-Govindan-Review December 12, 2011 19:10
Chapter 23•Gynecologic Cancers 327Answer 23.2.23. The answer is C.
Radiation is indicated for patients with more than one positive lymph
node and should be considered with any positive lymph nodes or if resec-
tion margins are positive and further resection is not possible. Chemother-
apy has not been demonstrated to be of benefit in the adjuvant setting.
A randomized trial evaluating the role of pelvic lymphadenectomy for
patients with positive groin lymph nodes was completed, suggesting there
is no role for routine pelvic lymphadenectomy for these patients. Pelvic
radiation therapy should be delivered to patients with positive groin
lymph nodes.Answer 23.2.24. The answer is A.
Local recurrence of vulvar cancer is not uncommon. These patients can
often be successfully managed with repeat resection. Large surgical defects
from further resections in the vulva can be managed with the use of
flaps and skin grafting. Chemotherapy is usually of limited efficacy and
not needed if the lesion is resectable. Radical surgical resection, includ-
ing pelvic exenterations, has been used successfully for large recurrent
cancers.Answer 23.2.25. The answer is B.
Exogenous estrogen use appears to cause a minority of endometrial can-
cers. In the past, when estrogens were given frequently to women with-
out progestins to protect the endometrial lining, this was a more frequent
cause of endometrial cancer. The majority (90%) of uterine corpus cancers
arise from the endometrium with sarcomas representing less than 10%
of cases. Abnormal uterine bleeding typically leads to early presentation
and evaluation of patients with endometrial cancer.Answer 23.2.26. The answer is C.
Risk factors for the development of endometrial cancer are typically
related to chronic estrogenic stimulation. Estrogen therapy, obesity, early
age of menarche, late age of menopause, anovulation, and estrogen-
producing tumors have all been associated with the development of
endometrial cancers. Interestingly, diabetes mellitus imparts an increased
relative risk of 3, even when controlling for other known factors.Answer 23.2.27. The answer is C.
Hysterectomy, whether performed through a large open incision,
laparoscopically, or vaginally, is indicated. Ovarian preservation has
been performed in rare circumstances but is typically discouraged.
Preoperative imaging, beyond a chest radiograph for patients with
disease apparently confined to the uterus on clinical examination, is rarely
helpful. Thus, CT, MRI, and PET scans are not typically recommended
as a preoperative evaluation for these patients. The office endometrial
biopsy is sufficiently accurate in this setting, and a D&C would not offer
any further benefit to the preoperative evaluation. Radiation can be used