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22 Cards in this Set
- Front
- Back
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What are the three most common sites of gynecological malignancies?
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ovary > uterine > cervix
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There are two types of endometrial carcinoma.
Which type is called Endometroid? UPSC/Clear Cell? Which type is not E-related, more aggressive, older and thinner, high grade/aytpical histo, posmenopausal? Which type is Estrogen-related, less aggressive, younger and heavier, low-grade histo, and perimenopausal? Which is more frequent? In which is the p53 mutation common? PTEN? KRAS2? Her-2-neu? |
I, II
Type II Type I Type I (80-85%) II (90%) I (80%) I II |
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What are some endogenous risk factors for endometrial cancer?
Exogenous? Exogenous protectants? |
OBESITY** --> the big one
NULLIPARITY HYPERTENSION TUMORS HIGH FAT DIET OTHER CANCERS AMENORRHEA DIABETES PCOS LIVER DISEASE CAUCASIAN NO EXERCISE Pelvic irradiation Hormone therapy Tamoxifen Sequential OCP Combination OCPs protective |
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Postmenopausal bleeding
Postmenopausal pyometria Postmenopausal woman with endometrial cells on pap Perimenopausal intermenstrual bleeding Premenopausal abnormal bleeding with history of anovulation Thickened endometrial stripe (depends on age) all these pts need what? |
endometrial Bx
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Do the endometrial cancers that arise from exposure to unopposed E --> hyperplasia tend to have a better prog than those that are spontaneous, and often in a field of atrophy?
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yes.
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Re: Type I endometrial adenocarcioma, is the fundus or the lower uterine segment a "better" place to get it re: risk of metastatic dz?
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fundus.
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What do we tend to do for pts with grade I endometrial cancer?
Grade II, III, UPSC & clear cell? On which lesions do we get progesterone receptors tested on? You should remove > ___ # of nodes in order to get an accurate prog? |
Pre-op CA125 & frozen section looking for myometrial invasion. If ^^ ca125 or invasion seen --> node dissection.
Just like Grade I, except node sampling in ALL pts. - omental sampling in selected UPSC & CC samples. all. 12. |
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Is smoking associated with a decreased or increased risk of endometrial cancer?
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decreased.
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Most ovarian cancers present in ____ stage. Incidence is ____ proportional to age up to age 80.
More common in which ethnicities? Generally chemo-responsive? Past Hx of breast, endometrial, or colon cancer (raises/decreases) risk of ovarian cancer? Will most women dx'ed with ovarian cancer be cured? There is less risk associated with (more/less) ovulation. Common associated genetic factors/syndromes? |
advanced
directly Scandinavian and Russian Jewish. Also, more common in industrialized nations yes raises. No. less. Hence pregnancy/BC = protective. **BRCA1 and 2 Gonadal dysgenesis Peutz-Jegher |
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Any woman who presents with ascites in the absence of liver dz has _____ until you can prove otherwise.
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ovarian cancer.
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What are the KEY sx of ovarian cancer?
Other sx? |
Bloated feeling, urgent need to urinate, puffed up stomach.
pain/pressure in lower abdomen difficulty eating normally constipation diarrhea nausea indigestion/gassiness WL |
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Ascites, bilateral masses, irregular borders, matted bowel, papillations, solid components, and thick septa (>2mm) are all fx of what on US?
What is US good at doing? Good screening method? Why can CA-125 lvls be misleading? Good screening? |
ovarian malignancy
Ruling out (specificity) It's sensitivity isn't so good tho'. - no. can be other malignacies, can be elevated for non-malignant reasons. - no. |
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Are there any available techniques currently suitable for large-scale, routine screening for ovarian cancer?
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No.
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What is the most important thing to do when tx'ing ovarian cancer with surgx?
- If you can't achieve this, should you try more aggressive surgx? - should you remove large, involved lymph nodes? |
reduce largest residual tumor to <2cm... even better if you can get no residual visual dz.
- no. - debatable. Probably not beneficial if there is large residual dz elsewhere. |
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What are the great new things to treat ovarian cancer discovered in the 1990s-2000s?
- admin? |
Taxols
Platin Inter-peritoneal might be better, still researching. |
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Are Taxol's and Platins well tolerated? what is the ~ response rate? Is this equivalent to the cure-rate?
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yes. ~75%
No! pts with advanced stage dz usually relapse. |
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What is the most common cause of death from cancer in women world-wide? Same as in the US?
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Cervical cancer
- no, only 13th here in the US. |
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Are the cervical cancer sx specific? What are they?
How do we screen? - summarize current guidelines. How to we tx: - early? - advanced? |
No, not really.
- chronic vaginal discharge, irregular vaginal bleeding, post-coital bleeding, pain (occurs later in dz process). Pap Smear. - start 3 years post-onset of vaginal intercourse (but no later then age 21). Discontine if >65yo w/ intact cvx and 3 or more neg smears + no hx of abnormal smears in the past 10y. --> continue if prior CaCx, immunosup., DES exposure in utero, HPV/dysplasia. - radical hysterectomy/lymph node dissection (or chemo is equally efficacious) - Xrt + chemosensitization (Cisplatin) |
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What is a trachelectomy?
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removal of the cervix.
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Which HPV's are the big players in cervical cancer?
Which are more associated w/genital warts? |
16 & 18
6,11 |
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Which HPV is also associated with Vulvar cancer?
- other risk factors for vulvar cancer? - most common presenting sx? - what should you do if you see a lesion on the vulva? - is there screening? |
HPV 16
- mostly postmenopausal, smoking, Vulvar Dysplasia (VIN), Immunodef, diabetes - itching (most common), burning, bleeding, nonhealing ulcer, persistent lump, pain. - biopsy it, you don't want to miss a cancer. - no. |
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HPV has 2 oncogenic proteins, what are they? What do they do?
How do we tx vulvar cancer? - advanced dz? chance of + nodes dramatically increases with what two factors? |
E6: b/p53
E7: b/Rb more tailored approach --> take out a vulvar section. use Chemo for + nodes, use chemo for advanced dz. Size of lesion and depth of invasion. |
