obgyn q?? - for2011

[ArchivalUser]

A 60-yo nulliparous woman is seen by her gynecologist for a followup appointment to discuss the results of an endometrial biopsy performed after a routine Papanicolaou (PAP) smear showed high-grade atypia. Pathology reports the endometrial sample is positive for carcinoma. What is the single most important factor is establishing the patient’s prognosis?
A. Depth of invasion
B. Histologic grade
C. Pelvic node metastasis
D. Positive peritoneal washings
E. Tumor volume

[ArchivalUser]

C.

[ArchivalUser]

Is it NBME?
I have seen similar one in NBME.
I think ans..is B.

[ArchivalUser]

I think the correct ans is D. Clinical stage and not grade defines prognosis for Endometrial CA. using the FIGO 2010 staging Abd metastasis offers the worst prognosis with a less than 15% 5yr survivsl. Unfair Q though!!!!

The 2010 Figo staging system is as follows: Carcinoma of the Endometrium

* IA Tumor confined to the uterus, no or < ½ myometrial invasion
* IB Tumor confined to the uterus, > ½ myometrial invasion
* II Cervical stromal invasion, but not beyond uterus
* IIIA Tumor invades serosa or adnexa
* IIIB Vaginal and/or parametrial involvement
* IIIC1 Pelvic node involvement
* IIIC2 Para-aortic lymph node involvement and/or pelvic lymph node involvement
* IVA Tumor invasion bladder and/or bowel mucosa
* IVB Distant metastases including abdominal metastases and/or inguinal lymph nodes

[ArchivalUser]

SS

[ArchivalUser]

This is a practice Question, NOT NBME.
Thanks!!

[ArchivalUser]

d is correct

[ArchivalUser]

Direct mode is the most common for metastasis to its surrounding areas.Not invasion,MC cause of death is metastasis in endometrial carcinoma.C or D,I go for CC.

[ArchivalUser]

not histo grades imp here.

[ArchivalUser]

+ve peritoneal washings indicate distal mets so if nodes r positive u can remove but not if other organs r involved
so it will be d