- most common gynecologic malignancy in the U.S
- predominantly a disease of obese postmenopausal women of low parity
Endometrial cancer
When should an endometrial biopsy be completed?
- postmenopausal bleeding
- perimenopausal intermenstrual bleeding
- abnormal bleeding with history of anovulation
- postmenopausal women with endometrial or glandulalr cells on pap smear
which endometrial hyperplasia has the highest risk of developing endometrial cancer?
complex hyperplasia with atypia
treatment of endometrial cancer?
- removal of uterus, fallopian tubes and ovaries
- peritoneal washings
- pelvic and lymphadnectomy
- surgical removal of extrauterine diseae
what is the endometrial cancer staging?
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
if a patient is too ill for surgery in endometrial cancer- OR they want to spare their fertility, what are the options?
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)
- Second most common gynecologic malignancy in the U.S
- most lethal gynecologic malignancy
- 70% of patients present with advanced disease
ovarian cancer
symptoms of ovarian cancer
can be vague and not gynecologic
* abdominal bloating, increased girth
* fatigue
* gastrointestinal disturbances
* urinary symptoms
* abdominal/pelvic pain
* menstrual irregularities
highest etiology for ovarian cancer?
papillary serous (75-80%)
mucinous (10%)
endometroid (10%)
factors that increase risk of ovarian cancer?
age
family history
infertility/low parity
use of infertility drugs
factors that decrease risk of ovarian cancer?
OCPs
multiple pregnancies
tubal ligation
breast-feeding
what hereditary factor has the highest incidence of ovarian cancer? when should risk reduction surgery be done?
BRCA 1 mutation (40-50%)
* risk reduction surgery = 35-45 years
BRCA 2 mutation (15-25%)
* risk reduction surgery= 40-45 years
- 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
CA125 testing
screening recommendations for ovarian cancer?
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)
Treatment of ovarian cancer?
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
Staging of ovarian cancer?
- 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
- arise from the sex cords or the ovarian stroma
- granulosa cell tumor- secret estrogen
- sx include: amenorrhea, breast atrophy, acne, hirsutism, receding hair line
Sex cord stromal tumors
- 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
Fallopian tube cancer
- can arise in women whose ovaries have been removed years earliers, espcially in women with genetic predisposition
- treatment is identical to ovarian cancer
primary peritoneal cancer
- 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
vulvar cancer
treatment of vulvar cancer
surgical
* wide local excision
* radical vulvectomy
* inguinal lymphadenectomy
radiation therapy
- 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
Vaginal cancer
