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8 Cards in this Set
- Front
- Back
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Endometrial Carcinoma
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Most common gynecological malignancy
Disease mostly seen in menapause Risks: Endogenous factors- Early menarche, late menapause, obesity, anovulation and estrogen secreting tumors Exogenous factors- Ingestion of unopposed estrogen Dx: No effective screening methods Presenting symptom –abnormal uterine bleeding mostly occuring after the menapause Examination, Pap smear and endometrial biopsy play a role Occasionally a D and C is necessary |
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Endometrial Carcinoma Management and Treatment
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Surgical staging used since 1988
Total abdominal hysterectomy and bilateral salpingo-oopherectomy along with peritoneal cytology are the basic treatment Intraoperative assessment of depth of invasion of the myometrium dictate whether lymph node sampling is indicated Surgical treatment- hysterectomy is primary treatment Any evidence of spread beyond 50% of the myometrium (above stage IC) or grade 2 or more cell type require postoperative radiation therapy |
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Cervical Carcinoma
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Median age 45-50
Seeing cases at younger ages Risk: Biological cause of cervical caarcinoma is unknown Infection with Human Papilloma Virus detected in 90-95% of cases Association with Herpes virus also seen Initiation of intercourse at an early age, multiple partners, and smoking have also been associated Dx: Most common symptom is abnormal bleeding or discharge Cytological evaluation-Pap smear- is the gold standard screening More recently viral testing also plays a role Colposcopically directed biopsy and/or cervical conization also needed Staging: Primarily determined by inspection and palpation of the cervix, vagina and pelvis Other tests such as chest Xray, IVP, and cystoscopy can also be used |
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Cervical Carcinoma Management and Treatment
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Early invasive cervical carcinomas-stage IA and IB can be managed surgically either with hysterectomy or with radical hysterectomy and pelvic radiation therapy
Stage II to IV carcinomas are usually treated with radiation therapy |
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Ovarian Carcinoma
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Leading cause of death from gyn malignancies.
Often diagnosed at an advanced stage 80% are epithelial carcinomas Risk: 1 in 70 lifetime risk Median diagnosis age 61 Higher incidence in nulliparity Increased with a family history or a prior diagnosis of breast or colon cancer Cause is unknown Suspect-high dietary fat, talc compounds, Protective factors-multiparity, BCP use, breast feeding and anovulatory disorders Dx: Suggested methods include pelvic examination, abdominal and transvaginal ultrasound and analysis of CA 125 levels in serum History- no early symptoms Physical findings- pelvic mass Workup includes-Ultrasound, chest Xray, other imaging tests as needed and tumor markers on occasion Staging: Surgical staging is indicated Extensive evaluation of the peritoneal cavity is essential Many different procedures may be indicated including- oopherectomy, hysterectomy, peritoneal cytology, omentectomy, lymph node dissection, peritoneal biopsies and bowel resection |
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Ovarian Cancer Treatment
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Primary treatment includes surgical debulking as previously described
Best prognosis is if all visible tumor is removed or extensive disease is debulked to less than 2cm nodules Post operative chemotherapy plays a major role Ocassinally follow up or second look surgery is used |
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Vulvar Carcinoma
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Uncommon tumor
5% of all gyn malignancies. 90% are squamous cell carcinomas Average age of diagnosis is 65 years Risk: Multifactorial Younger women more likely HPV virus Older women more likely related to squamous hyperplasia Immunosuppression may play a role Dx: Most frequent symptom is itching or pruritis Most common sign is a vulvar mass Diagnosis is based on biopsy Spreads via direct extension, lymphatic or hematogenous routes Staging: Surgical staging Based on evidence of lymph node metastasis |
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Vulvar Cancer Treatment
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Early stage I disease is managed by local excision
If there is evidence of more than 1mm of invasion then ipsilateral groin node dissection is indicated More advanced stages are managed with radical vulvectomy and bilateral lymph node dissections Stage IV disease can occasionally be treated with pelvic exenteration Post operative radiation also plays a role with positive lymph nodes |
