446 Obstetrics and Gynecology Board Review •••
❍ Explain why PCO syndrome, obesity, estrogen secreting ovarian tumor, or liver disease can increase the risk
of developing endometrial carcinoma?
The unopposed estrogen effect can be related because of the absence of progesterone effect, the overproduction of
estrone or estradiol, and the increased free-biologically active fraction of estrogen because of the decreased level of
steroid hormone binding globulin (SHBG) produced by the liver.
❍ In whom should a diagnosis of endometrial cancer be excluded?
(1) All patients with postmenopausal bleeding.
(2) Postmenopausal women with a pyometra.
(3) Asymptomatic postmenopausal women with endometrial cells on a Papanicolaou smear.
(4) Perimenopausal women with intermenstrual bleeding or increasingly heavy menses.
(5) Premenopausal women with abnormal uterine bleeding, particularly if they are anovulatory.
❍ The background endometrium in a uterus with typical endometrioid endometrial adenocarcinoma
histologically represents what process?
Endometrial hyperplasia of varying types (asynchronous proliferative pattern).
❍ What effect does the prior use of OCPs have on the development of endometrial cancer?
Women who use combination OCP for at least 12 months have a relative risk of endometrial cancer of 0.6. This
protective effect persists for at least 15 years after cessation of OCP use.
❍ Epidemiologically how many types of endometrial cancer are there?
Two:
(1) Type I is estrogen related and occurs on a background of endometrial hyperplasia. This type occurs in younger
women and has a good prognosis.
(2) Type II occurs predominantly in older women, appears to arise de novo, and is unassociated with estrogen
excess. The histologic grade is high and histopathologic types associated with aggressive behavior (clear cell,
papillary serous) are common. The prognosis is poorer.
❍ What is the most common presenting complaint of a woman with endometrial cancer?
Postmenopausal bleeding (or abnormal uterine bleeding in the premenopausal woman).
❍ What is the most common cause of postmenopausal bleeding?
Atrophy
❍ Describe the indicated office evaluation of a woman whose history is suspicious for endometrial cancer.
Pelvic examination, Pap smear, biopsy of any abnormal cervical or vaginal lesion, and endometrial biopsy.
❍ What percentage of endometrial carcinomas will shed abnormal cells that can be seen on a cervicovaginal cytology?
25% to 35%.
❍ After which day of the menstrual cycle is the presence of endometrial cells a cause for concern?
After day 14. Some authors would use day 10. During menses and immediately thereafter the presence of
endometrial cells in a Pap smear is normal.