Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
46 Cards in this Set
- Front
- Back
|
Which HPV genes are incorporated into cervix cells as part of the tumorigenesis of cervical cancer?
|
E6 and E7
|
|
|
CIN I of the cervix will resolve spontaneously in what percentage of patients?
|
60%.
|
|
|
What is the appropriate management of a woman with signs and symptoms of cervical cancer who has a normal Pap smear?
|
Continue the workup, as the false-negative rate may be as 50% even with invasive cancer.
|
|
|
What are the management options for women with early stage cervical cancer (no lymphovascular space invasion)?
|
Simple hysterectomy if fertility is not a concern, or observation following conization if it is.
|
|
|
What is the appropriate management of women with early stage cervical cancer with high risk features (lymphovascular invasion, greater than 3 mm depth, or clinically visible lesions)?
|
Radical hysterectomy (complete removal of the uterus, cervix, upper vagina, and parametrium) and lymph node dissection. Those with addition high risk features such as positive nodes, positive margins or positive parametria require adjuvant cisplatin based chemotherapy WITH CONCURRENT radiation.
|
|
|
Cervical cancers of stage IB2 (> 4 cm in greatest dimension) are managed differently than other early stage cervical cancers in what way?
|
Chemoradiation without RADICAL surgery.
|
|
|
What is the treatment approach to extensive local cervical cancers (stage IIB to IVA)?
|
No role for primary surgery. Chemoradiation followed by brachytherapy.
|
|
|
In cervical cancer patients who have recurrence following primary treatment of localized diesease and have had radiation already, what option should be considered, and what portion of patients treated with this modality have long-term DFS?
|
Pelvic exenteration.
|
|
|
What are the two most commonly used chemotherapy regimens in cervical cancer?
|
Cisplatin-Taxol and Cisplatin-topotecan.
|
|
|
What percentage of women with complex (as opposed to simple) endometrial hyperplasia with atypia will develop invasive cancer?
|
25%.
|
|
|
What is the average age at diagnosis for endometrial cancer?
|
60.
|
|
|
What percentage of endometrial cancers are diagnosed at an early stage?
|
80%
|
|
|
Which increases risk of endometrial cancer, estrogen-only replacement therapy or combination estrogen-progestin therapy?
|
Estrogen only raises the risk. Combined therapy may lower risk.
|
|
|
What is the relationship between smoking and risk of endometrial cancer?
|
Smoking lowers the risk, likely through an anti-estrogen effect.
|
|
|
Women with HNPCC have an increased risk of endometrial cancer; what is the percentage increase in lifetime risk? How should they be screened?
|
20-60% increased risk and they should be screened with annual endometrial biopsy even in the absence of symptoms.
|
|
|
Approximately what percentage of women with postmenopausal vaginal bleeding will have endometrial cancer?
|
15%
|
|
|
Which histologic subtypes of endometrial cancer show a propensity toward deep invasion, lymph node involvement and metastatic spread?
|
Papillary serous and clear cell.
|
|
|
How is endometrial cancer staged?
|
Surgically, with TAH-BSO, washings, pelvic and para-aortic LN dissection and examination of the entire abdominal cavity.
|
|
|
Which early-stage endometrial cancers can be managed with surgery alone, with a 5-year survival of about 83%?
|
Those with stage IA or IB tumors that are confined to the endometrium or extend to <50% of the MYOmetrium and are low grade. If the tumor is high-grade or involves >50% of the MYOmetrium, consider radiation +/- chemotherapy.
|
|
|
How are the risk factors of age and high-risk features integrated in the overall risk stratification in endometrial cancer?
|
High-risk factors are: Grade 2 or 3, outer third invasion of the myometrium, and lymphovascular invasion. High-intermediate risk patients are those 70 or older with one risk factor, 50 years or older with two risk factors, or any age with three risk factors.
|
|
|
How are stage II (tumor invading the uterine cervix) endometrial cancers managed?
|
Stage IIA is managed the same as high-risk stage I (hysterectomy with consideration of pelvic + intravaginal radiation +/- chemo). The benefit of adjuvant radiation and chemo is under investigation.
|
|
|
How is stage III (locoregional spread) endometrial cancers managed?
|
If there is no residual tumor > 2 cm in the peritoneal cavity, combination chemotherapy (cisplatin + doxorubicin, Taxol is also active) is given.
|
|
|
What percentage of endometrial cancers will respond to progrestation agents? What factors are predictive of response?
|
10-30%. Grade 1 or 2, long disease-free interval, presence of ER or PR receptors on the tumor cells.
|
|
|
How do uterine carcinosarcomas differ in their behavior from endometrial cancers? How are they treated?
|
Uterine carcinosarcomas are at high risk for recurrence. All stages are treated with adjuvant combination chemo (ifofsamide + Taxol or carbo-Taxol)
|
|
|
How do uterine leiomyosarcomas behave? How are they managed?
|
They tend toward early hematogenous spread (50-70% recurrence even in stage I-II tumors). The current standard is observation. Chemotherapy regimens include ifofsamide, doxorubicin, and combination gemcitabine-docetaxel)
|
|
|
How do endometrial stromal sarcomas behave and how are they managed?
|
They are low-grade and usually receptor-positive. Hormone blockade is the standard approach. There is a high-grade variant that are high risk/receptor negative.
|
|
|
What effect does oral contraceptive use (for at least 5 years) have on risk of ovarian cancer?
|
RR is 0.5 for OCP users.
|
|
|
In what percentage of patients with early stage ovarian cancer is CA-125 elevated? In patients with advanced cancer?
|
50% and 80%.
|
|
|
In the United States, an appropriate and complete staging procedure is carried out in what percentage of patients with suspected early-stage ovarian cancer?
|
15%.
|
|
|
What is the appropriate management of stage IA or IB ovarian cancer?
|
Assuming complete surgical staging, they do not benefit from adjuvant chemotherapy.
|
|
|
Which groups of patients with early stage ovarian cancer should receive adjuvant cisplatin-based chemotherapy?
|
All stage I-II Grade 3 cancers, stage IC (pelvic extension with positive washings), all clear-cell carcinomas, all stage II patients
|
|
|
How is advanced or metastatic ovarian cancer managed in the first-line setting?
|
Platinum-taxane chemotherapy (usually carbo-Taxol).
|
|
|
What is the role and benefit of intraperitoneal chemotherapy for ovarian cancer?
|
In stage III disease that has been optimally cytoreduced, adding IP cisplatin plus IP and IV Taxol increases PFS and OS, at the cost of greater toxicity and an initial decrease in QOL.
|
|
|
What is the benefit of consolidation chemotherapy in advanced ovarian cancer?
|
12 monthly cycles of consolidation with Taxol improves PFS by about 7 months (to 28 months), at the cost of alopecia and increased risk of neuropathy.
|
|
|
Define "platinum sensitive", "platinum refractory" and "platinum resistant".
|
Platinum sensitive = recurrence occurs > 12 months after completion of therapy.
Platinum refractory = progresses on first-line therapy with a platin Platinum resistant = recurrence occurs < 6 months after completion of therapy. |
|
|
How are platinum refractory patients with ovarian cancer best managed?
|
Clinical trial.
|
|
|
How should platinum sensitive patients with ovarian cancer be managed when they recur?
|
Retreat with cisplatin based combination chemotherapy (Taxol, Gemzar), although this increases the risk of acquired allergy to Carboplatin.
|
|
|
How should platinum-resistant patients with ovarian cancer be managed when they recur?
|
Multiple agents have activity in the second-line setting, including doxorubicin, Doxil, topotecan, Gemzar, Taxol, weekly paclitaxel, oral etoposide, irinotecan, vinorelbine. Tamoxifen can be used with low-volume disease and Avastin has also been used.
|
|
|
How should patients with ovarian cancer who recur between 6-12 months after completion of therapy be managed?
|
Response rate to platinum based therapy exceeds 20%, otherwise choose a second-line agent based on patient characteristics.
|
|
|
What is the average time until disease progression with sequential second line agents in recurrent ovarian cancer?
|
About 4 months.
|
|
|
What is the appropriate management of low malignant potential tumor of the ovary?
|
Fertility-sparing surgery is possible, otherwise proceed as normal for ovarian cancer.
|
|
|
Granulosa-type tumors of the ovary (a type of sex cord tumor, not to be confused with germ cell tumors) are managed how?
|
Fertility-sparing surgery is possible in young women, otherwise TAH-BSO. Adjuvant chemotherapy is not usually given, but there is some data supporting the use of combination platinum-based chemotherapy for recurrent or unresectable disease.
|
|
|
What are the characteristics of Sertoli-Leydig tumors of the ovary in terms of patient age, stage at presentation, paraneoplastic effects, and prognosis.
|
Commonly diagnosed before age 40. Most are diagnosed at stage I (90%). Androgen production can lead to virilization. Long term survival is excellent for early stage, well-differentiated tumors but unfavorable for advanced stage or poorly differentiated cancers.
|
|
|
Which two types of germ cell tumors of the ovary are managed differently than the others?
|
Dsygerminomas and immature teratomas of early stage have a good prognosis and can be treated with surgery (with/without fertility sparing), but all other germ cell tumors (yolk sac, embryonal, nongestational choriocarcinoma, mixed tumors) should be treated with adjuvant chemotherapy.
|
|
|
What is the overall prognosis for patients with gestational trophoblastic disease, and how is response to treatment assessed?
|
These are highly curable cancers and they are followed using hCG levels.
|
|
|
What chemotherapy agents are used in combination regimens for gestational trophoblastic disease?
|
Single agent methotrexate for low risk disease. Also dactinomycin and etoposide. High risk patients are given etoposide, MTX and dactinomycin alternating with cyclophosphamide and vincristine.
|
