Gynecologic Malignancies

Question 1

• most common gynecologic malignancy in the U.S
• predominantly a disease of obese postmenopausal women of low parity

Answer 1

Endometrial cancer

Question 2

When should an endometrial biopsy be completed?

Answer 2

• postmenopausal bleeding
• perimenopausal intermenstrual bleeding
• abnormal bleeding with history of anovulation
• postmenopausal women with endometrial or glandulalr cells on pap smear

Question 3

which endometrial hyperplasia has the highest risk of developing endometrial cancer?

Answer 3

complex hyperplasia with atypia

Question 4

treatment of endometrial cancer?

Answer 4

• removal of uterus, fallopian tubes and ovaries
• peritoneal washings
• pelvic and lymphadnectomy
• surgical removal of extrauterine diseae

Question 5

what is the endometrial cancer staging?

Answer 5

Stage 1- confined to uterus
Stage 2- cervix involved
Stage 3- uterine, serosa, adnexa, vaginal metastasis, pelvic/periaortic lymph
Stage 4- bladder, bowel, inguinal node, distant metastasis

Question 6

if a patient is too ill for surgery in endometrial cancer- OR they want to spare their fertility, what are the options?

Answer 6

To ill: whole pelvic radiation therapy or IUD

Fertility Sparing: progesterone containing IUD and/or oral progesterone (will need to repeat biopsies to determine effect of therapy)

Question 7

• Second most common gynecologic malignancy in the U.S
• most lethal gynecologic malignancy
• 70% of patients present with advanced disease

Answer 7

ovarian cancer

Question 8

symptoms of ovarian cancer

Answer 8

can be vague and not gynecologic
* abdominal bloating, increased girth
* fatigue
* gastrointestinal disturbances
* urinary symptoms
* abdominal/pelvic pain
* menstrual irregularities

Question 9

highest etiology for ovarian cancer?

Answer 9

papillary serous (75-80%)
mucinous (10%)
endometroid (10%)

Question 10

factors that increase risk of ovarian cancer?

Answer 10

age
family history
infertility/low parity
use of infertility drugs

Question 11

factors that decrease risk of ovarian cancer?

Answer 11

OCPs
multiple pregnancies
tubal ligation
breast-feeding

Question 12

what hereditary factor has the highest incidence of ovarian cancer? when should risk reduction surgery be done?

Answer 12

BRCA 1 mutation (40-50%)
* risk reduction surgery = 35-45 years
BRCA 2 mutation (15-25%)
* risk reduction surgery= 40-45 years

Question 13

• tumor marker that can be elevated in greater than 80% of advanced epithelial ovarian cancers
• elevated in on 20-50% of stage 1 cancers
• has poor specificity, especially in premenopausal women
• not a screening test for the general population

Answer 13

CA125 testing

Question 14

screening recommendations for ovarian cancer?

Answer 14

No family history or 1 family member with cancer
* annual recotovaginal pelvic exam

2 or more family members with cancer
* genetic counseling, consider genetic testing
* annual rectovaginal pelvic exam
* CA125, transvaginal ultrasound (benefit unproven)

Question 15

Treatment of ovarian cancer?

Answer 15

surgical treatment - (in women NOT desiring fertility, THA-BSO and LND)
* fertility may be spared with the removal of affected ovary and lymph nodes

Chemotherapy

Question 16

Staging of ovarian cancer?

Answer 16

• Stage I - tumor involving one or both ovaries
• Stage II- Tumor involving one or both ovaries with pelvic extension
• Stage III- tumor involving one or both ovaries and extending beyond pelvis (abdominal disease)
• Stage IV- tumor involving ovaries with distant metastases such as to liver parenchyma

Question 17

• arise from the sex cords or the ovarian stroma
• granulosa cell tumor- secret estrogen
• sx include: amenorrhea, breast atrophy, acne, hirsutism, receding hair line

Answer 17

Sex cord stromal tumors

Question 18

• metastases from primary sites, most often ovary, endometrium, GI tract and breast
• classic symptoms: Prominant watery vaginal discharge, pelvic pain and a pelvic mass
• tx- is identical to ovarian cancer

Answer 18

Fallopian tube cancer

Question 19

• can arise in women whose ovaries have been removed years earliers, espcially in women with genetic predisposition
• treatment is identical to ovarian cancer

Answer 19

primary peritoneal cancer

Question 20

• Associated with HPV and older women
• smoking, cervical cancers, immunosuppresion, chronic irritants, HTN and obesity risk factors
• sx include: pruritis, pain, bleeding, ulceration, enlarged inguinal lymph nodes
• mainly squamous cell carcinoma

Answer 20

vulvar cancer

Question 21

treatment of vulvar cancer

Answer 21

surgical
* wide local excision
* radical vulvectomy
* inguinal lymphadenectomy

radiation therapy

Question 22

• usually asymptomatic
• advanced disease presents with bleeding, mass, foul-smelling discharge and pain
• squamous cell carcinoma most common
• tx: if in upper 1/3 of vagina- partial or complete radical vaginectomy; whole pelvic radiation + brachytherapy; pelvic exenteration

Answer 22

Vaginal cancer