Gyn Onc Sub I Flashcards
(141 cards)
1
Q
Lifetime risk of tumors of uterine corpus
A
1:37
2
Q
Lifetime risk of tumor of ovary
A
1:75
3
Q
Death percentage for uterine cancer
A
1/5
4
Q
Death percentage for ovarian cancer
A
2/3
5
Q
death percentage for cervical cancer
A
1/3
6
Q
Death percentage for vulvar cancer
A
1/5
7
Q
Pathogenesis of ovarian cancer
A
Repeated ovulation/trauma/repair of epithelium
excess gonadotropin secretion _. increased esrogen _.. epithelial proliferation
8
Q
site of origin
A
fimbriae
9
Q
Risk factors for Ovarian Cancer
A
Long ovulation history, nuliparity, family hx of cancer, estrogen replacement
10
Q
Decreased risk of ovarian cancer
A
increased parity, OCP, TL, hysterectomy
11
Q
symptoms of ovarian cancer
A
bloating, abdominal pain, urinary symptoms, constipation
12
Q
prevalence of adnexal masses
A
2-8%
13
Q
Prevalance of adnexal masses in premenopausal
A
7.8% (6.6% are simple cysts)
14
Q
Prevalence of adnexal mass in post-meno
A
2.5%
15
Q
cystic mass with normal CA-125
A
repeat US in 6 mo
16
Q
what causes elevated CA-125 besides OC?
A
uterine ca, colon ca, breast ca, stomach ca, liver, ca, endometriosis, PID, liver, heart, kidney, failure, pregnancy
17
Q
HE4
A
new ovarian cancer TM, if both elevated concerning
18
Q
CEA
A
GI tract marker
19
Q
CA19-9
A
mucinous or pancreatic tumor
20
Q
Beta HCG
A
embryonal, choriocarcinoma
21
Q
AFP
A
endodermal sinus, embroynal
22
Q
LDH
A
dysgerminoma
23
Q
Inhibin A and B
A
granulosa cell
24
Q
when to refer for pelvic mass?
A
elevated CA125, ascites, nodular or fixed mass, evidnece of mets, family hx of 1+ 1st degree relatives
25
Ovarian Stage IA
Limited to ovary - intact capsule
26
Ovarian Stage IB
tumor both ovaries, but intact capsule
27
Ovarian IC
Tumor to one or both
1C1: surgial spill
1C2: capsule rupture prior to surgery
1C3: malignant cells in ascites
28
Ovarian stage I
confined to ovaries
29
Ovarian Stage II
Involves 1 or both ovaries w/ pelvic extension below pelvic brim or primary peritoneal
30
IIA ovarian cancer
extension to uterus or tubes
31
IIB ovarian cancer
other pevlic intraperitoneal tissues
32
Stage III ovarian cancer
spread to peritoneum outside pelvis or retroperitoneal lymph nodes
33
Stage IIIA Ovarian
positive RP LN
34
Stage IIIA2 Ovarian
microsopic extrapelvic + RP LN
35
Stage IIIB Ovarian
Macroscopic extrapelvic <2cm + LN (capsule of liver or spleen)
36
Stage IIIC Ovarian
Macroscopic extrapelvic >2cm + LN (capsule of liver or spleen)
37
Stage IV ovarian
distant mets
38
Stage IV A ovarian
pleural effusion
39
Stage IV B ovarian
hepatic or splenic parenchymal
40
Type I vs Type II Ovarian cancer
Type I: low grade, clear cell, mucinous, borderline (20-25%
slowly growing; primary site ovarian epithelium
Type II: high grade, p53 mutations, 75-80%, primary site FT
rapidly aggressive
41
Schiller Duval Bodies
Endodermal sinus tumor
42
Call exner bodie
Granulosa cell tumor
43
Why primary debulking
increased overall survival
improved GI function
less tumor - fewer cells to kill - less opportunity for resistance
increased # cells in active phase
44
Stroma tumor tx
surgery is primary tx --> BEP
45
Germ Cell tumor tx
conservative surgery -> BEP or BVP
46
Platinum refractory
progress on chemo
47
platinum resistant
recur <6 mo
48
how much of Ovarian tumors are genetic
10%
70-75% BRCA1
20% BRCA2
2% Lynch
49
Significant family hx for BRCA
2 first deg relative with breast or ovary cancer, one <50
One UL breast cancer <30
one bilatereal BC <40
one male BC
50
Lifetime risk of OC with BRCA1
39-66%
51
lifetime risk for BRCA2 OC
10-27%
52
Lifetime risk of OC w/ MMR
9-12%
53
Life time risk of endometiral cancer with MMR
20-60%
54
risk of OC at 40 with BRCA1/2
2-3%
55
risk of OC at 70 with BRCA 1/2
46% and 12%
56
what age start Mammograms and MRI for BRCA`
25
57
what age to start OC screening for BRCA
35
58
Risk reduing BSO
95% reduction
59
risk reducing mastectomy
40-50%
60
Risk factors for endometrial cancer
Unopposed Estrogen, obesity, late meno, nulliparity, DM, HTN, tamoxifen, endometrial hyperplasia
61
Risk of progression with Simple w/o atypia
1%
62
Risk of progression with Simple w atypia
8%
63
Risk of progression with complex w/o atypia
3%
64
Risk of progression with comple w/ atypia
29-50%
65
protective factors for endometrial cancer
OCPs, pregnancy, smoking
66
symptoms of uterine cancer
Abnormal bleeding
67
Spread of endometrial cancer
direct extension, transtubal, lymphatic, hematogenous
68
Stage I endometrial Cancer
confined to uterus
69
Stage IA Endo Ca
<50% myometrial
70
Stage IB endo Ca
>50% myometrial
71
Stage II Endo Ca
invasion of cervical stroma, but not beyond uterus
72
Stage III endo Ca
Local or regional spread
73
Stage IIIA endo CA
Invades serosa of corpus and/or adenxa
74
Stage IIIB endo CA
vaginal or parametrial
75
Stage IIIC end CA
mets to pelvic or PA nodes
76
Stage IVA endo CA
bladder or bowel
77
Stage IVB endo CA
distant mets
78
Adjuvent therapy for endometrial CA
radiation and ct
79
medical managmeent of endometrial cancer
progesterone or anti-estrogen
80
Stage IA tx of endo CA
Observation + VBT for high grade
81
Stage IB tx of endo CA
Observe + VBT or pelvic RT for high grade
82
Stage 3 and 4 tx of endo CA
surgical debulk --> CT and RT
83
how much decrease in cervical cancer after PAP
75%
84
LSIL
CIN1 mild dysplasia
85
HSIL
CIN2 - mod dys
| CIN3 severe dys or CIS
86
HPV 16 accounts for how much cerivcal dyplasia
50%
87
average time of clerance of HPV
8-24 mo
88
9 valent vax for HPV
6, 11, 16, 18, 31, 33,45, 52, 58
89
Regression rates of CIN1 vs CIN 3
57% v 43%
90
Persistence rate of CIN1 vs CIN3
32% v 56%
91
Progression to cancer of CIN 1 v CIN3
1% v >12%
92
Symptoms of cervical cancer
post coital bleeding, abnomral bleeding, vaginal discharge, pelvic or back pain, bowel or urinary symptoms
93
Stage I Cervix
confined to cervix
94
Stage IA cervix
Microsopic only depth <5mm and <7mm wide
95
Stage IB cervix
1B1 <4cm
| 1B2 >4cm
96
Stage II Cervix
extends beyond cervix but not to pelvic wall, and upper 1/3 vagina
97
Stage IIA cervix
no parametrial, upper 2/3 vag
98
Stage IIB cervix
parametrial invovememnt
99
Stage III cevix
to pelvic sidewall and lower 1/3 vagina, hydronephrosis
100
Stage IIIA cervix
lower 1/3 vagina, but no side wall
101
Stage IIIB cervix
extension to pelvic sidewall or hydronephrosis
102
how is cervical cancer staged?
clinically
103
how are lower stages of cervical cancer treated?
radical hyst
104
middle stages of cervical cancer tx
rad hyst v radiation
105
advanced stages cervical cancer
chemo RT
106
above what stage gets Radiation and no rad hyst for cervical cancer
Stabe IB2
107
Complications of rad hyst
1% fistula
| 20-80% lower urinary tract dysfucntions - abnormal sstraining, storage dysfunction, recurrent UTI, incontience
108
intermediate risk factors for cervical cancer that require adjuvent RT
>1/3 stromal invasion, LVSI, tumor diameter >4cm
109
High risk factors of cervical cancer that warrant adjuvent RT
positive nodes, positive margins, microsopic disease on parametrium
110
prognosis for stage I cervical ca
80-90%
111
prognosis stage II cerivcla cancer
60%
112
prognosis stage III cervcial cancer
30%
113
prognosis stage IV cervical cancer
<16%
114
VIN usual types
warty, basaloid, mixed
| associated with HPV
115
differentiated VIN
associated with lichen sclerosis and p53
| 3-5% of LS
116
how much % of VIN pogress to vulvar cancer
10-16%
117
types of vulvar cancer
90% squamous
10% melanoma
2-3% basal cell
2% adenocarcinoma- intra-epithelial pagets
118
medical therapy for vulvar cancer
topical imiquimod 5% 3x week for 12-20 wks
119
Recurrence of VIN
30-50%
120
Stage I Vulvar
confined to vulva
1A <2cm
1B >2 cm
121
Stage II vulva
extension to adjacent -- lower 1/3 urethra, 1/3 vagina, anus negatie node
122
Stage III vulva
lower 1/3 vagina or urethra, or anus + inguinal femoral LN
IIIA; 1 LN >5mm or 1-2 <5mm
IIIB: 2 LN > 5mm or 3+ <5mm
IIIC: + LN w/ extracapsular spread
123
Stage IV vulva
2/3 upper urethra, uper vagina, distant
124
5y survival of Stage I Vulvar
80%
125
5y survival of stage II Vuvlar
60%
126
nodeal invovlement in vulvar cancer
<2mm 0%
| >2mm 20%
127
morbidity of vulvectomy
lymphedema 25-35%
infection 40-60%
wound breakdown 15-25%
128
tx stage I and II vulvar
WLE or hemivulvectomy
| margin 2cm
129
when should vulvar tumors have BL LNE
2cm of midline
130
nodal sites of vulvar cancer
inguinal and femoral
131
Metastatic sites of vulvar cancer
pelvic nodes or extrapelvic mets
132
investigations for Vulvar lesion
1) cervical cytology
2) colposcopy
CT MRI of pelvis and goins
CXR
blood work
133
Stage IA Vulvar tx
WLE w/o LNE
134
when is radiation warrented in vulvar cancer
extracapsular LN spread
| 2+ groin nodes
135
complete mole histology
Diploid 46 XX - both Xs from paternal origin
| florid cistern, trophoblastic prolif, absence of fetal parts
136
partial mole histology
Triploid w/ materal and paternal genetic origin
| fetal parts
137
Choriocarcinoma
malignant tumors of absence of chrionic villi
abnormal syncytiotrophoblasts and cytotrophoblasts
distant spread to lungs
138
molar pregnancy presentation
abnormal bleeding in pregnancy
hyperemesis gravidarum
hyperhyroidism
snow storm apperance
139
Gestational trophoblastic neoplasia tx
low risk: methotrexate or actinomycin D
| high risk: etoposide methotrexate and actinomycin, cyclophosphamide, vincrstine
140
prognostic factors in gestational trophoblaist disease
```
age <40
mole, abortion, term
interval from pregnancy
pretreatment bHCG
largest tumor size
site of mets
number of mets
previous failed chemo
```
141
surgery in GTN
hysterectomy for unctrolle dbleeding, but use embolization
