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Uterine Cancer Module Post Test Instructions: Download this document to your computer and give it a NEW NAME. Print off, email or use the drop-box feature in ANGEL when you have completed this post test. To receive credit for this assignment, this document should go to your clerkship director. Please return CD by the last day of class. Please place an “X” next to the answer you feel is correct. CASE: Ms. Johnson, an obese, 64 year-old, Caucasian woman, gravida 1, para 1, comes to see you because she is having post menopausal bleeding over the past month. She has no other symptoms. She has not been receiving hormone replacement therapy with estrogen or progesterone. 1. Of the following risk factors for developing endometrial cancer, which are the most significant in the patient’s history: _____A. Amount of vaginal bleeding _____B. Obesity _____C. Patient age _____D. Number of pregnancies 2. Had this patient been taking oral post menopausal estrogen therapy she would be at higher risk of developing endometrial cancer. There is an indisputable link between “unopposed” estrogen therapy and the risk of developing endometrial cancer. Of the following variables of estrogen usage, which has the significant impact of that risk? _____A. Types of hormone _____B. Dose of hormone _____C. Duration of use (years) _____D. Age of initiation of therapy On physical exam, the patient is noted to weigh 232 lbs and her height is 5’5”. On pelvic exam it is difficult to assess the size of her uterus, however it appears to be slightly enlarged. You perform an endometrial biopsy and submit it for pathological evaluation. 3. Based on this scenario, the most likely histology is: _____A. Clear cell _____B. Endometrioid _____C. Papillary Serous _____D. Mixed histology The results of the biopsy showed an endometrioid adenocarcinoma, moderately differentiated (grade 2). Based on this result, you recommend that the patient have surgery. Copyright 2008 UC Regents 4. The recommended surgery for this condition is exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH & BSO) and: _____A. No other biopsies _____B. Pelvic lymphadenectomy _____C. Para-aortic lymphadenectomy _____D. Pelvic and para-aortic lymphadenectomy Patient undergoes a hysterectomy and staging. The tumor is grade 2 and invades one half of the muscle wall. There are no metastasis to the pelvic or para-aortic lymph nodes. 5. Based on these findings, her stage is: _____A. Stage I _____B. Stage II _____C. Stage III _____D. Stage IV Based on these finding this patient was recommended and received pelvic radiation therapy. 6. Based on her stage and treatment, the probability of her five-year disease-free survival: _____A. 85% _____B. 70% _____C. 50% _____D. 30% 7. In women with endometrial cancer, the likelihood of cure is lower in AfricanAmerican women compared with Caucasian women in the U.S. What is the difference in survival at 5 years? _____A. 5% _____B. 10% _____C. 15% _____D. 25% 8. The treatment of endometrial cancer has an impact on subsequent sexual functioning. The most significant decrease in the frequency of the sexual activity is found after which of the following treatments for stage I disease? _____A. Hysterectomy _____B. Radiation therapy _____C. Hysterectomy plus radiation therapy _____D. Chemotherapy Copyright 2008 UC Regents 9. Following the treatment of stage I endometrial cancer with a hysterectomy in an obese woman, the patient should be counseled to lose weight, because obesity increase the subsequent risk of: _____A. Recurrent endometrial cancer _____B. Cervical cancer _____C. Breast cancer _____D. Colon cancer 10. Conservative treatment (use of hormonal therapy with preservation of the uterus) is used for selected young patients (<35 years of age) with well differentiated stage I endometrial cancer. Compared to a woman who does not have the disease, fertility in these women is significantly: _____A. Abrogated _____B. Decreased _____C. Unchanged _____D. Increased Copyright 2008 UC Regents