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86 Cards in this Set
- Front
- Back
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clinical signs endometrial CA
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-abnormal thicking of endometrium
-abnormal bleeding |
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What is the most common gynecologic malignancy in North America
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Endometrial CA
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Endometrial CA is associated with
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elevated estrogen levels
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What is the most common way endomential CA spreads
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thru the lymph nodes
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what are some premenopausal conditions that can be signs/causes of endometrial CA
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dysfuntional uterine bleed w/no ovulation
endometrial hyperplasia stein-levinthal syndrome (PCOS) |
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What post menopausal conditions are related to endometrial CA
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thecoma tumor
granulosa tumor HRT tomoxafin therapy |
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What are the risk factors to developing endometrial CA
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abnormal bleeding
endo hyperplasia PCOS (Stein Leventhal syn) thecoma tumor granulosa tumor HRT Tomoxafin therapy obesity nulliparity late onset menopause |
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Why is late onset menopause a risk factor for Endo CA
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Due to no longer producing estrogen
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What is the most common form of gyn malignancy typically found in post menopausal women
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endo CA
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how is CA progression noted
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in stages
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how is staging determined
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based upon of tumor spread and amt of invasion into myometrium, surrounding adnexal structures and beyond (liver and breast)
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What is carcinoma in situ
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involves only the cells in the tissue in which CA began
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What is the primary sympton of Endometrial CA
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discharge
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Treatment of endometrial CA
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always TAH/BSO
random testing of pelvic and para aortic lymph nodes possible radiation or chemo |
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What is the normal msmt of the endometrium post menopause
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6-7 mm
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What does TAH stand for?
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Total abdominal hysterectomy
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BSO
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bilateral salphingo oophrectomy
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what is prognosis for endometrial CA
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5 yrs survival:
75-95 for stage 1 50% for stage 2 30% for stage 3 less than 5% for stage 4 |
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What is the U/S appearance on Endo CA
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thickened endometrium
hypoecholic halo (myometrial envasion) around endo pelvic and abd. ascites lymphadenopathy (enlarged lymph) |
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what are the differential dx for endo CA
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endo hyperplasia
endo polyps endo myoma endo Carcinoma |
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What procedure can help determine the dx for endo ca
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sonohysterography
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leiomyosarcoma
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smooth muscle tumor that undergoes a malignant transformation
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what makes one suspect leiomyosarcoma
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rapid fibroid growth noted on serial us scans
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a leiomyosarcoma is indistiguishable from a
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myoma
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when can a leiomyosarcoma be DX
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surgery
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why have leiomyosarcomas decreased in the last few years
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awareness
accuracy of pap smears early dx of cervical CA |
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what are the risk factor for leimyosarcoma
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early sexual activity
multiple partners HpV infection and DES exposure |
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What measurement is considered to be a thickened endometrium (premenopause)
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greater than 4 or 5 mm
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demonstration of ____________ ___________ is clear evidence of Endometrial CA
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myometrial invasion
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Ppl on Tamoxifen therapy are at higher or lower risk for developing endometrial ca
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higher
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How is endometrial CA staged
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based upon the amt of tumor spread & amt of invasion into the myometrium surrounding adnexal structures and beyond (liver and breast)
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Carcinoma in Situ
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involves only the cells in the the tissue where the cancer began
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What are the clinical symptoms of endometrial CA
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1. typically occurs btw 60 and 70 yrs.
2. pain due to uterine distention 3.PMB or discharge 4. only confirmed by D&C and endo Bx |
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What is the treatment for endometrial CA
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always TAH/ BSO
random testing of pelvic and paraaortic lymph nodes possible chemo and reditation |
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What is the U/ S appearance of endometrial CA
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1. normal in early stages to thickened, irregular endo in late stages
2. Endo-w/ hypoechoic halo 3. pelvic and abd. ascites 4. lymphadenopathy (enlarged lymph nodes) |
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Leiomyosarcoma
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smooth muscle tumor that undergoes a malignant tranformation
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What do leiomyosarcomas arise from?
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arise from preexisting leiomyoma's. Very rare
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Is a leiomyosarcoma distinguishable from a myoma?
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no
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how do you dx leiomyosarcomas
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surgery
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What are 3 reasons Endometrial CA has decreased in the last few yrs
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1. awareness
2. accuracy of pap smears 3. early dx of cervical CA |
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What two types of cells form the lining of the cervix
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1.squamous epithelium
2. columnar epithelium |
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squamous cell epithelium
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mucosal covering of the lower cervix
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What part of the lining of the cervix gives rise to squamous cell CA
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squamous epithelium
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where are 90-95% of all cervical lesions found
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squamous epithelium
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which cells of the cervix give rise to adenocarcinoma
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columnar epithelium
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what part of the cervix does the columnar epithelium line
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cervical canal
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what is the average age of diagnosis of cervical CA
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45
CIS often dx at 25-40 |
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Gestational trophoblastic disease (GTD)
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abnormality of villi
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during development the egg divides into embryo and placenta.The placenta contains _______ which invade into the lining of the uterus
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villi
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What is GTD
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abnormal growth of cells w/in the uterus developing form placental trophoblastic tissue
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When does GTD usually occur
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shortly after the implantation of fertilized ovum but can also occur yrs after any type of pregnancy. Can grow fast.
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trophoblast
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layers of cells which surround the embryo; produce villi which develop into th eplacenta
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1 egg + 1 sperm +
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23 pairs
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when does GTD most commonly occur
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during or shortly after implantation of fertilized ovum but can also occur yrs after any type of preg.
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do the cells with GTD grow fast or slow
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very fast
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villi
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fingerlike projections
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tropho
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nutrition
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blast
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early developmental cell
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trophoblast
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layers of cells which surround the embryo; produce villi which develop into the placenta
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what are the 3 types of GTD
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1. hydatidiform Mole
2. invasive mole 3. choriocarcinoma |
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what is hydatidiform also know as?
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molar pregnancy, snowstorm or vesicular
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Describe a hydatidiform Mole or Molar pregnancy
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1. no fetal development but placental elements continue to grow
2. hydropic villi 3. overgrowth of the extra embryonic cells (syto and syncytrotrophoblast) 4. exaggerated symptoms of preg due to HCG 5.molar chromosomes are paternal in nature 6. palpable,enlarged uterus |
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Where do most cases of GTD or Molar pregnancies occur
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Tawain
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What is the incidence of Gestational Trophoblastic disease in the US
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1 of 82 births
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what are the three risk factors of molar pregnancies
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1. adv. maternal age
2. previous Molar pregnancies 3. ethnicity (asian highest incidence) |
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Can a Mole and Fetus coexist
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Yes, but rare
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excessive chorionic growth leads to increasing or decreasing HCG?
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increasing
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What are two types of hydatidiform Moles
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partial and complete
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describe how Partial or incomplete hydatidiform moles occur
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occurs when 2 sperm fertilize an egg, creating an abnormal fetus and abnormal placenta (instead of forming twins)
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what types of tissue does a partial hydatidiform have
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fetal and trophoblastic
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how many chromosomes does a partial hydatidiform have
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69XXY, 69, XXX, 69XYY
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describe a complete hydatidiform mole
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-swollen villi with fluid
-no baby -no fetus -chromosome 46 XX -paternal -pts present very sick |
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how are a partial and complete hydatidiform mole different?
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partial: fetus and 69 chromosomes
complete: no fetus and 46 chromosomes |
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Invasive Mole
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chorioadenoma Destruens
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What is an invasive mole
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a hydatidiform mole that penetrates into the myometrium and possibly thru the uterine wall
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what are some characteristics of invasive moles
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-hydropic villi
-forms hemorrhagic masses -invasive (spreads in same organ but does not metastisize |
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how are invasive moles treated
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referred to oncologist for chemo and radiation
d&c does not work |
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choriocarcinoma
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cancer of the chorionic membrane that surrounds the fetus.
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How is choriocarcinoma different from hydatidiform moles
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don't contain villi
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how does a choriocarcinoma form
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from a complete hydatidiform mole but can also occur after a normal preg or abortion
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what other organs is choriocarcinoma most likely to spread too
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lungs and brain
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Risk factors for GTD
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-prior molar pregnancy
-blood type (women type A/ men type O) -deficiency of carotene -over age 40 |
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clinical symptoms of GTD
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-persistant vag. bleeding
-elevation of HcG levels -hyperemesis (vomiting) |
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U/S appearance fo GTD
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-increased uterine msmt
-echogenic masses w/in endo -highly vascular endo -theca lutein cysts |
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differential Dx for GTD
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-early failed preg
-retained products of conception (POC) -degenerating uterine fibroid |
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What does a hypoechoic halo around the endometrium suggest
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myometrial invasion
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