Carcinoma of Uterus and Ovaries - Tieman

Question 1

leiomyoma regression

Answer 1

stimulated by estrogen

-so post-menopausal women - regresses

Question 2

ovary gonadostromal tumor

Answer 2

produce estrogen

-so get endometrial hyperplasia**

Question 3

most common female genital tract malignancy

Answer 3

uterine carcinoma

Question 4

abnormal vaginal bleeding in perimenopausal/postmenopausal women

Answer 4

uterine carcinoma

Question 5

risk fx for uterine carcinoma

Answer 5

obesity
unopposed estrogen stimulation - permarin
tamixifen
nulliparity
diabetes
late menopause
PCOS
lynch syndrome

Question 6

ovarian carcinoma

Answer 6

most LETHAL

because presents late

Question 7

obesity

Answer 7

increased estrogen - fat cells secrete androstenedione - converted to estrogen

Question 8

decreased risk of uterine carcinoma

Answer 8

ovulation
progestin therapy
combo BCPs**
eraly menopause
multiparity

Question 9

complex atypical hyperplasia

Answer 9

not cancer - but 8x increased risk

recommend TAH-BSO

Question 10

endometrial carcinoma staging

Answer 10

done surgically**

Question 11

stage 1a endometrial carcinoma

Answer 11

confined to endometrium

Question 12

stage 1b endometrial carcinoma

Answer 12

invasion to <1/2 myometrium

Question 13

stage 1c endometrial carcinoma

Answer 13

invasion to >1/2 myometrium

Question 14

stage 2 endometrial carcinoma

Answer 14

invades endocervical canal

Question 15

stage 3 endometrial carcinoma

Answer 15

tumor in peritoneum, vagina, nodes

Question 16

stage 4 endometrial carcinoma

Answer 16

distant mets

Question 17

evaluation of abnormal vaginal bleeding

Answer 17

pelvic exam/pap smear
endometrial sampling
transvaginal U/S
fractional D and C

Question 18

endometrial stripe

Answer 18

should be <5mm

Question 19

favorable histo of endometrial carcinoma

Answer 19

endometroid

Question 20

grade

Answer 20

differentation

Question 21

lymph drainage of endometrial cancer

Answer 21

iliac/para-aortic nodes

Question 22

stage 1, grade 1 and 2 endometrial cancer

Answer 22

TAH-BSO
peritoneal washings
removal enlarged nodes

Question 23

stage 1c or 2, grade 3 endometrial cancer

Answer 23

TAH-BSO
cytology
iliac/paraaortic node dissection - with radiation

Question 24

stage 3 and 4 endometrial cancer

Answer 24

surgical debulking
radiation
chemotherapy

remove everything that looks bad - to make chemo/rad work better

Question 25

fractional D and C

Answer 25

to see if cancer to endocervical canal stage 1 vs. 2

Question 26

increased risk of ovarian carcinoma

Answer 26

``` white nulliparity/infertile late childbearing late menopause fam hx BRCA** ```

Question 27

decresed risk of ovarian carcinoma

Answer 27

ovulation interrupted ``` oral contraceptives multiparity breast feeding tubal ligation hysterectomy ```

Question 28

most lethal cancer female genital tract

Answer 28

ovarian due to late stage of disease at diagnosis increasing girth, pelvic fullness, pelvic discomfort most patient - stage 3 or 4 age 50-70yo

Question 29

ovarian cancer screening

Answer 29

non proven to be effective

Question 30

beta-HCG

Answer 30

choriocarcinoma

Question 31

AFP

Answer 31

dermoid ovarian cancer

Question 32

CA125 and 19-9

Answer 32

epithelial derived

Question 33

most ovarian cancers

Answer 33

majority serous epithelium B9 and low grade - not removed - young women who still want children

Question 34

ovarian cancer spread

Answer 34

internal iliac, common iliac, paraaortic nodes

Question 35

germ cell tumors

Answer 35

dysgerminomas and teratomas

Question 36

granulosa thecal cell tumor

Answer 36

secrete E/PR

Question 37

sertoli-leydig cell tumor

Answer 37

secrete androgens

Question 38

ovarian cancer staging

Answer 38

done surgically

Question 39

stage 1 ovarian cancer

Answer 39

confined to ovary

Question 40

stage 2 ovarian cancer

Answer 40

tumor spread confined to pelvis

Question 41

stage 3 ovarian cancer

Answer 41

confined to abdominal peritoneal surfaces or retroperitoneal nodes

Question 42

stage 4 ovarian cancer

Answer 42

distant mets

Question 43

optimal cytorecuduction

Answer 43

get rid of every part of tumor

Question 44

ovarian cancer treatment

Answer 44

radiation or platinum based chemotherapy dependent upon stage, histology, and grade of tumor

Question 45

stage 1 low grade ovarian cancer tx

Answer 45

no further tx

Question 46

stage 1 high grade ovarian cancer tx

Answer 46

platinum based chemo - paclitaxel

Question 47

germ cell tumor of ovary tx

Answer 47

platinum based chemo, blemycin, etoposide

Question 48

gonadal-stromal tumors of ovary

Answer 48

relatively chemoresistant

Question 49

most important aspect of tx for long term prognosis of ovarian cancer

Answer 49

excision of any visible tumor

Question 50

bowel prep

Answer 50

mandatory for ovarian ca surgery bc may be location of spread - and may need to take it