Top 10 Most Commonly-Missed CREOG Questions

Endometrial carcinoma is the most common gynecological cancer in the United States. It manifests mainly as abnormal uterine bleeding in both pre- and postmenopausal women. There is no established routine screening algorithm for the general population. Screening endometrial biopsies and risk-reducing hysterectomy are considered in women with Lynch syndrome. Risk factors for endometrial cancer include obesity, polycystic ovary syndrome, increasing age, and Lynch syndrome. Treatment of early stage endometrial cancer is surgical and consists of hysterectomy with bilateral salpingo-oophorectomy via laparoscopy or laparotomy. Universal lymph node evaluation is controversial, especially in patients with well-differentiated superficially invasive tumors. If the risk of tumor lymphatic spread is estimated to be elevated, pelvic and para-aortic lymph node dissection is recommended. It is warranted with certain clinic scenarios, including serous or clear cell, or high-grade histology; deep myometrial invasion greater than 50%; or tumors extending into the cervix.

Endometrioid type (A) or type I endometrial cancer is less severe than other tumor types and is considered to be well differentiated and does not require lymph node dissection due to low risk of nodal spread. Low-grade histology (B) is also not an indication for lymph node dissection. Myometrial invasion of 40% (C) is indicative of early disease. Lymph node dissection is indicated when invasion is 50% or more.