GYN and GU cancers Flashcards
(50 cards)
how would you describe GYN cancers?
cancers that affect tissue and organ of the female reproductive system
what do we know about ovarian, peritoneal, and fallopian tube cancers?
they all arise from the same set of cells
what are the risk factors associated with ovarian cancer? median age of dx?
age, early menarche (<12y), late menopause (>52y), HRT or fertility drugs, first pregnancy >30y, obesity
63y median age at dx
greater than 70% of people with ovarian cancer have:
stage III/IV disease
what genes are commonly associated with ovca?
BRCA1/2, STK11, RAD51D, MLH1, MSH2, EPCAM, BRIP1, RAD51C (also MSH6, PMS2, TP53)
what is the BRCA1/2 mutation prevalence in ashkenzai jewish ind with epithelial ovca vs. non-jewish ind
40% AJ vs. 10% non-AJ
what other gyn cancers are associated with mutations in BRCA1/2?
fallopian tube, primary preitoneal
what is the cumulative risk (up to 20y) for peritoneal cancer following oopherectomy?
3.9-4.3%
how do we screen for ovarian cancer? limitations?
CA-125 (poor sensitivity in early stages), pelvic exam, transvaginal U/S (poor sensitivity in early stage, cannot reliably distinguish benign from malignant changes)
insufficient evidence for pop. screening, low prevalence of ovca in gen pop, not cost-effective, appropriate screening is undefined
what factors decrease risks for ovca?
multiparity, breast-feeding, OCP usage, oophorectomy, tubal ligation – any time you STOP shedding ovary/oocyte tissue)
what ways can we try to prevent ovca?
chemoprevention: OCP (esp. young women with increased risk), limit infertility drug use, limit HRT
surgical: oophorectomy, bilateral tubal ligation (72% risk reduction when used with OCP)
what are the benefits and risks with prophylactic oophorectomy?
benefits: 80-96% risk reduction in high-risk women) -> **residual risk for peritoneal cancers & decreases brca risk in premenopausal women
risks: loss of endogenous estrogen (impact heart, bones, sexual function), the effect of HRT options, emotional risks
what is the risk of occult invasive cancer after preventative surgery?
3.4%
when should we consider RRSO with various mutations? what if they decline?
BRCA1 -> 35-40y
BRCA2 -> 40-45 (depends on FHx)
if decline: TVUS and CA-125 @ 30-35y but not considered sensitive or specific enough to recommend
what are the mean age of onset for ovca with BRCA1/2?
1: 48y (28-78y)
2: 50.6 (29-74y)
what recommendation can we make for ovca risk reduction in Lynch syndrome?
TAHBSO (remove uterus, ovaries, fallopian tubes, and cervix)
Changes in which genes should lead you to consider/recommend RRSO?
BRCA1/2, Lynch genes, BRIP1, RAD51C, RAD51D
what are the tiers of somatic variants?
I-IV I: STRONG clinical evidence II: potential clinical evidence III: VUS IV: benign or likely benign
How do PARP inhibitors impact cancer cells?
lead to an increase in dsDNA breaks by influencing the failure of ssDNA repair, arrest replication fork -> dsDNA breaks
when are PARP inhibitors available?
BRCA1/2 and PALB2 variants (inherited and somatic) for metastatic brca and ovca
when can we can pts access immunotherapy? benefits?
indicated for Lynch syndrome and MSI-high tumors
first drug not limited to tumor location but rather indication of MMRD
what are some of the risk factors for uterine and endometrial cancers?
obesity, age, class/race/FHx, irregular menstrual periods, early menarche or late menopause, low or nulliparity, infertility, diabetes, hypertension, estrogen replacement therapy and/or tamoxifen, hereditary predisposition
what are some symptoms of uterine and endometrial cancers? how does it’s progression/dx compare to ovca?
unusual vaginal spotting, bleeding, discharge, pain in the pelvic region, presence of a lump
typically earlier onset which leads to a better prognosis
what are the various types of hysterectomy?
partial: only uterus
total: uterus and cervix
radical: uterus, cervix, vagina, ovaries, fallopian tubes
