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NM By Myself > Gyn Cancer NM > Flashcards

Gyn Cancer NM Flashcards

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1
Q

Corpus uteri N

A

10% in stage I
Pelvic or paraaortic - - 50% reduced 5-year survival
2/3 lower drain like cervix
1/3 upper drain directly to paraaortic

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2
Q

Corpus uteri M

A

Lung - - hormonal therapy
Liver
Bone
Skin

Inguinal LN (above renal pelvis)
Peritoneal implants
Malignant ascites

Stage IVB

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3
Q

Corpus uteri cancer
Risk

A

Hyperestrogenism - - nullipara, anovulation, premature menarche, late menopause, polycystic ovaries, tamoxifen therapy, HRT
Obesity
Comorbidities - - arterial hypertension, DM, Lynch

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4
Q

Corpus uteri cancer
Endometrioid type 80%

A

Estrogen - dependent
Type 1
Earlier - - Better prognosis
Precede - endometrial hyperplasia
Ass with chronic estrogen exposure
Mutations of PTEN, PIK3CA, K-Ras, beta-catenin genes

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5
Q

Corpus uteri cancer
Non Endometrioid

A

Estrogen independent
Type 2
Papillary and clear cell
Aggressive, extrauterine
serous (prototype of type 2)
clear cell carcinoma (features of type 1 and 2)
No ass with estrogen exposure, no premalignant disease

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6
Q

Corpus uteri treatment

A

TAH + BSO
High risk - - grade 3, >50% myometrial invasion, papillary serous, carcinosarcoma and clear cell carcinoma - - radical pelvic and paraaortic lymphadenectomy

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7
Q

Corpus uteri sarcoma

A

Leiomyosarcoma - - rare LN
Endometrial stromal sarcoma
Adenosarcoma

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8
Q

Leiomyosarcoma

A

15-40% smooth muscle tumor
>40 y
Large, 6-10 cm
>5 cm - - poor prognosis
Recurrence in lungs 40%
FDG avid in primary tumor and MTS
CT - enlarged uterus with areas of necrosis

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9
Q

Endometrial stromal sarcoma

A

10-25% mesenchymal tumor
>35-55 y
Large mass with myometrial component
Spreads along fallopian tubes, uterine ligaments, pelvic veins
Often sensitive to hormones
High rate of recurrence
CT - - enhancing mass, loss of pelvic fat planes

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10
Q

Adenosarcoma

A

6% benign epithelium and malignant stroma
Polypoid mass with septa, lattice like appearance, expands endometrial cavity
Large, up to 9 cm
May protrude through dilated cervical canal
Recurrence in vagina and pelvis
CT - large solid mass, regions of necrosis, small cystic areas

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11
Q

Corpus uteri sarcoma
Risk

A

Risk - - tamoxifen therapy or long term COCs, previous pelvic radiation
Aggressive - - intense FDG uptake

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12
Q
A

Endometrial cancer

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13
Q

Uterus PET indication

A

Evaluation of extrauterine disease
Patient selection and surgical planning
Response to therapy, recurrence
Early stage only if high risk

Not for primary staging, early carcinomatosis, microMTS, low grade, serous or mucinous

PET MRI - - infiltration in surrounding tissue

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14
Q

PET false

A

False negative:
Lesion <1 cm
Grade I endometrial cancer
Well-diff mucinous ovarian cyst adenocarcinoma
Small pelvic tumor adjacent to bladder or ureter
Peritoneal carcinomatosis

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15
Q

Uterus benign PET

A

Uterine fibroid
Adenomyosis
Endometriosis
Cyclic activity of uterus or ovary in premenopausal women

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16
Q

Oral metformin PET

A

Diffuse uptake in bowel
Stop 48h

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17
Q

PET after treatment
Cancer of uterus

A

After surgery or chemo - - 2 weeks
After radio - - 6-12 weeks

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18
Q

Cervical cancer FIGO

A

Ia2 - stromal invasion 3-5 mm
Ib1 - stromal invasion >5 mm
Ib2 - visible lesion 2-4 cm
IIa1 - visible lesion <4 cm

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19
Q

Cervical cancer N

A

Drain to parametria, external iliac, obturator LN (most common SLNB)
1/3 of locally advanced - - paraaortic LN MTS

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20
Q

Cervical cancer M

A

Liver
Lung
Bone (spine)
Adrenal

Mediastinal LN
Supraclavicular LN

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21
Q

Cervical cancer origin

A

Squamocolumnar junction (ectocervix intra vagina) - - moves to endocervix with age - - cancer arise in transformation zone between old and new SCJ

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22
Q

Cervical cancer type

A

SCC 70% - - cavitary lung MTS - - highest FDG SUV
Adenocarcinoma - - 25%, aggressive
Small cell - - 2%, PAP smear not sensitive, aggressive
Clear cell adenocarcinoma - - exposure to diethylstilbestrol in utero
Adenoma malignum - - from columnar epithelium of endocervical canal, history of copious watery discharge, poor prognosis, ass with Peutz-Jeghers

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23
Q

Cervical cancer risk

A

90% HPV16, 18
Early sex
Multiple partners
STD
Multiparity
Smoking
Long use of COC

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24
Q

Postcoital bleeding

A

Anemia

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25
Peritoneal seeding
Sister Mary Joseph's LN (umbilical)
26
Cervical cancer Paraneoplastic sy
Cushing SIADH Carcinoid Hypoglycemia
27
Cervical cancer Paraaortic LN
Predictor of recurrence Important for treatment strategy Surgical staging
28
Cervical cancer PET MRI
Useful for IB2, soft tissue and Parametrial involvement
29
Hysterectomy
Only if N0
30
Conization
Depth of tumor invasion <3 mm N0
31
Wertheim - Meigs operation
TAH Upper 1/3 of vagina Parametrial and uterosacral ligament Pelvic and paraaortic LN
32
Cervical cancer CT
92% accurate for stage IIIB-IVB Not for Parametrial invasion
33
Cervical cancer MRI
Ideal for local staging Accurate in selecting operative candidates Superior soft tissue contrast
34
Cervical cancer FDG PET
100% sensitivity and 99% specificity for LN >5 mm and for MTS >MRI and CT in adenopathy Higher SUV on primary lesion or metastatic pelvic/paraaortic LN - - increase risk of adverse events and death NCCN - - IB2 or higher ACR - - IB1 or higher When paraaortic LN found at surgery Incidental invasive cervical cancer at hysterectomy To define targets for radiotherapy planning Suboptimal for early stage 3 - 6months after chemo radio Not for routine unless proven recurrence
35
Cervical cancer
36
Cervical cancer
37
Cervical cancer
38
Ovarian cancer M
Liver: Perihepatic - - smooth, elliptic - - stage III - - resectable Parenchymal - - less defines, surrounded by parenchyma - - stage IV, non resectable Lung Pleural effusion Adrenal Spleen Bone Intestine - - morbidity
39
Ovarian cancer epithelial 90%
High grade serous 70% - - precursor - - serous tubal intraepithelial carcinoma, TP53 and BRCA Low grade serous 5% - - precursor - - ovarian surface epithelial inclusion cysts, KRAS and BRAF Clear cell Endometrioid - - endometrial hyperplasia Mucinous - - variable density
40
Ovarian cancer non epithelial 10%
Germ cell
41
Calcification in cysts
Serous
42
Suspicious malignancy ovary
Solid mass with necrosis Non fat nodular components in cystic lesion Irregular thick wall or septa >3 mm Vascularity Enhancement Ascites, peritoneal MTS, lymphadenopathy
43
CA 125 > 30 U/mL
Premenopausal Endometriosis Cystadenoma Pelvic inflammatory disease Peritoneal dissemination of non ovarian cancer
44
Malignant ascites
Peritoneal MTS Omentum
45
Primary peritoneal carcinona
Poor prognosis Biopsy to confirm Partially solid/cystic mass separate from ovary associated with hydrosalpinx No hydrosalpinx - - sausage shaped solid adnexal mass At least stage II
46
Latzko classic triad Primary peritoneal cancer
Intermittent profuse serosanguinous Vaginal discharge Colicky pain relieved by discharge Adnexal mass
47
Ovarian cancer
48
Mature cystic teratoma
49
Ovarian cancer
50
Ovarian cancer MRI
Problem solving When CT is contraindicated Better in DD benign vs malignant Local extension Local recurrence
51
Ovarian cancer PET CT
Tumor characterisation, local extent, nodal involvement, MTS >US, CT, MRI in staging of epithelial cancer, regional LN, peritoneum esp in right upper abdomen and small bowel mesentery, residual SUV at staging predict survival Locally advanced epithelial cancer treated with neoadjuvant therapy - - responders vs non responders Corpus luteum cyst - - high uptake in premenopausal Not optimal for lesions <5 mm
52
Vaginal cancer
30-50% had prior hysterectomy 90% SCC - - HPV, post menopause 10% adenocarcinoma - - exposure to DES, congenital T-shaped uterus, young FDG useful in recurrence
53
Vulvar Stage
Ib - T1b - lesion <2 cm II - T2 - any size, adjusent perineal structures
54
Vulvar cancer LN
Inguino-femoral Labia - - superficial inguinal Midline - - deep inguinal bilateral
55
Vulvar cancer risk
Smoke Lichen sclerosis Intraepithelial neoplasia HPV 60%
56
Vulvar cancer Unilateral dissection
Unifocal tumor <2 cm Lateral lesion >1 cm from midline No palpable adenopathy
57
Vulvar cancer Bilateral dissection
Tumor >2 cm Central lesion Nodal MTS Complications - - better SLNB
58
Vaginal cancer
59
Vulvar cancer PET CT
Staging Recurrence Treatment planning SLNB still required
60
PET MRI
Management of patients with cervical and ovarian cancer Less useful in endometrial carcinoma
61
PET MRI > PET CT
Superior for detecting small metastatic LN and for distinguishing LN from anatomic structures
62
2 on the right 1 on the left
63
External iliac bilaterally

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