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Clinical: Gynecologic Oncology Flashcards

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1
Q
  • Majority of ovarian cancers: 95%
  • Average age at Dx: 63 years
  • Most aggressive form of ovarian cancer

Epidemiology

A

Ovarian carcinoma

High-grade serous carcinona = most aggressive ovarian cancer

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2
Q
  • 25% of all ovarian neoplasms; only 1% of cancers
  • Account for 70% of ovarian tumors in ages 1-20

Epidemiology

A

GCT

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3
Q
  • Account for 3% of all ovarian cancers
  • Average age at Dx: 40s

Epidemiology

A

Sex cord-stromal cancers

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4
Q

TP53 mutation

Genetic Abnormalities

A

Associated with high-grade ovarian serous carcinoma, endometrial serous carcinoma

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5
Q

Inactivation of BRCA1/2

Genetic Abnormalities

A

Associated with high-grade ovarian serous carcinoma

Inactivation: mutation or hypermethylation

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6
Q

KRAS mutation

Genetic Abnormalities

A

Associated with low-grade ovarian serous carcinoma, ovarian mucinous carcinoma, endometrial endometrioid carcinoma

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7
Q

BRAF mutation

Genetic Abnormalities

A

Associated with ovarian mucinous carcinoma

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8
Q

PIK3CA mutation

Genetic Abnormalities

A

Associated with low-grade ovarian serous carcinoma, ovarian endometrioid carcinoma, ovarian clear cell carcinoma, endometrial carcinoma (types 1 & 2)

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9
Q

ARID1A mutation

Genetic Abnormalities

A

Associated with ovarian endometrioid carcinoma, ovarian clear cell carcinoma

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10
Q

PTEN mutation

Genetic Abnormalities

A

Associated with ovarian endometrioid carcinoma, endometrial endometrioid carcinoma

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11
Q
  1. Advancing age
  2. Obesity
  3. Nulliparity
  4. Endometriosis
  5. Early menarche / late menopause
  6. Genetic factors
A

Ovarian cancer

Risk Factors

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12
Q
  • 40% lifetime risk of ovarian cancer
  • 60-80% lifetime risk of breast cancer

Risk Factors: Genetic

A

Inactivation of BRCA1

Chromosome 17

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13
Q
  • 20% lifetime risk of ovarian cancer
  • 60-80% lifetime risk of breast cancer

Risk Factors: Genetic

A

Inactivation of BRCA2

Chromosome 13

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14
Q
  • Increased risk of colon cancer
  • 60-80% lifetime risk of endometrial cancer
  • 10% lifetime risk of ovarian cancer (10%)

Risk Factors: Genetic

A

Lynch syndrome / HNPCC

HNPCC: hereditary non-polyposis colorectal cancer

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15
Q
  1. Oral contraceptive pills
  2. Multiparity
  3. Lactation
  4. Tubal ligation
  5. Opportunistic salpingectomy
A

Ovarian cancer

Protective Factors

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16
Q
  • Bloating
  • Abdominal pain
  • Weight changes
  • Early satiety
  • Changes in stool caliber
  • Constipation
  • Vaginal discharge

Symptoms

A

Ovarian cancer

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17
Q

Endometriosis

Risk Factor

A

Increased risk: clear cell ovarian cancer; endometrioid ovarian cancer

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18
Q

LDH

Markers

A

Dysgerminoma

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19
Q

Schiller-Duval bodies

Histological Hallmarks

A

Endodermal sinus tumor

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20
Q

AFP

Markers

A
  • Endodermal sinus tumor
  • Embryonal carcinoma
  • Immature malignant teratoma
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21
Q

B-hCG

Markers

A

Choriocarcinoma

Syncytioblasts produce B-hCG

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22
Q

Most common malignant GCT
* Most common in women age < 30
* Bilateral: 15-20% of cases

Epidemiology

A

Dysgerminoma

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23
Q

Most common ovarian GCT
* Bilateral: 12% of cases

A

Mature cystic teratoma (dermoid cyst)

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24
Q

Most common ovarian GCT
* Bilateral: 12% of cases

Study These Flashcards
A

Mature cystic teratoma

25
Carl-Exner bodies | Histological Hallmarks
Granulosa cell tumor
26
Granulosa cell tumor | Risk Factor
Increased risk for endometrial carcinoma (10%) | Due to estrogenic effects
27
FOXL2 mutation | Genetic Abnormalities
Associated with granulosa cell tumor
28
Inhibin B | Markers
Granulosa cell tumor
29
* Lymphocytic infiltrate * Multinucleated giant cells | Histological Hallmarks
Dysgerminoma
30
Coffee bean nuclei | Histological Hallmarks
Granulosa cell tumor
31
Reinke crystals | Histological Hallmarks
Leydig cell tumor
32
Rokitansky's tubercle | Histological Hallmarks
Mature cystic teratoma (dermoid cyst)
33
Psammoma bodies | Histological Hallmarks
Ovarian papillary serous carcinoma
34
Hobnail cells | Histological Hallmarks
Ovarian clear cell carcinoma
35
Ovarian mucinous carcinoma | Associations
Associated with pseudomyxoma peritonei
36
MLH1 mutation | Genetic Abnormalities
Associated with HNPCC | MLH1: DNA MMR gene
37
MSH2 mutation | Genetic Abnormalities
Associated with HNPCC | MSH2: DNA MMR gene
38
1. Obesity 2. Genetic syndromes (e.g., Lynch) 3. Endometrial hyperplasia 4. Tamoxifen use
Endometrial cancer | Risk Factors
39
1. Smoking 2. Combined oral contraceptive 3. Intrauterine contraceptive device
Endometrial cancer | Protective Factors
40
MSI mutation | Genetic Abnormalities
Associated with endometrial cancer
41
* Accounts for 80% of uterine cancers * Clinical setting: excess unopposed estrogen & endometrial hyperplasia * Well-differentiated / low-grade * Favorable prognosis | Epidemiology
Type 1 endometrial carcinoma: endometrioid
42
* Accounts for 20% of uterine cancers * Non-estrogen dependent * Clinical setting: atrophic endometrium or polyps * Poorly-differentiated / high-grade * Poor prognosis | Epidemiology
Type 2 endometrial carcinoma: papillary serous, clear cell or carcinosarcoma (MMMT) * High-risk histologies | MMMT = malignant mixed mesodermal tumor
43
Uterine tumor containing a malignant epithelial component & a malignant mesenchynal component | Pathology
Carcinosarcoma (MMMT)
44
Atypical endometrial hyperplasia | Treatment
* Fertility-sparing: progesterone; oral, Mirena IUD * Non-fertility sparing: simple hysterectomy
45
Related to high-risk HPV infection 1. Early onset of sexual activity 2. Multiple / high-risk sexual partners 3. History of STIs 4. Immunosuppression 5. History of VIN / VAIN 6. Smoking
Cervical cancer | Risk Factors
46
* Associated with high-risk HPV infection * Risk factors: smoking; immunosuppression * HPV-16 most common * More common in younger women: 40s-50s * Progresses to warty & basaloid carcinoma * High-grade * Long time to progression | Epidemiology
VIN, usual type
47
* Often associated with lichen sclerosis * 5% of LS will develop SCC within 10 years * Usually not associated with HPV infection * More common in older women: 70s * Progresses to invasive SCC * Well-differentiated * Short time to progression
Differentiated VIN | VIN, keratinizing type
48
Vulvar Paget's Disease | Treatment
Wide local excision
49
Drains to inguinal lymph nodes first, followed by pelvic lymph nodes | Pathology
Vulvar cancer
50
Early stage vulvar cancer | Treatment
Vulvectomy with lymph node dissection (LND)
51
VIN | Treatment
Wide local excision
52
Most common site of extramammary Paget's disease | Epidemiology
Vulva
53
2nd most common vulvar malignancy | Epidemiology
Vulvar melanomoa
54
Most common finding in vulvar melanoma | Epidemiology
Pigmented lesion
55
1. Asians 2. Diet low in animal fat, carotene, Vit A 3. Extremes of reproductive years 4. History of infertility / many abortions 5. Blood type A / AB
Gestational trophoblastic disease | Risk Factors
56
HPL | Markers
Gestational trophoblastic neoplasia (GTN)
57
Low-risk GTN | Approach to Therapy
Single agent CTX w/ methotrexate or actinomycin D * If no response to MTX, can switch to act-D * Rx for GTD if pt. has renal insufficiency: act-D
58
High-risk GTN or choriocarcinoma | Approach to Therapy
Multi-agent CTX w/ EMA-CO * E = etoposide * M = methotrexate * A= actinomycin D * C = cyclophosphamide
59
GTD | Approach to Therapy
Surgical: D&C

GU / GYN & Renal (23 decks)

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