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Women's Health Rotation > Neoplasms part 2 > Flashcards

Neoplasms part 2 Flashcards

1
Q

Type I endometrial CA

A

Caused by unopposed estrogen stimulation
Usually endometroid histology
Generally good prognosis- 90% cure stage I
About 70% diagnosed stage I

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2
Q

Type II endometrial CA

A

Unrelated to estrogen stimulation
Usually nonendometroid histology (clear cell, papillary serous)
Worse prognosis

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3
Q

RFs for endometrial CA

A

Obesity- extraovarian aromatization of androstenedione to estrone
Granulosa-theca cell ovarian tumors- about 15% have endometrial CA
Chronic anovulatory cycles (Stein-Leventhal syndrome)
Postmenopausal pts treated with unopposed ERT
Long-term tamoxifen
Alcohol intake: 2 or more drinks per day

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4
Q

Obesity and gynocologic CAs

A

BMI >35 is associated with increased mortality compared with nl wt in ovarian, cervical CA, and endometrial CA

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5
Q

What is the MC tx for endomtrial CA?

A

TAH with bilateral salpingo-oophorectomy

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6
Q

Endometrial carcinoma screening and prevention

A

In high risk pts- annual endometrial sampling and TVUS beginning at age 30-35
OCPs- possible chemoprevention
Risk-reducing hysterectomy for atypical endometrial hyperplasia

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7
Q

Endometrial adenocarcinoma

A

MC, typically postmenopause
Associated with excessive estrogen exposure
Often dx-ed with endometrial hyperplasia

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8
Q

Types of endometrial CA

A

Adenocarcinoma
Adenosquamous
Clear cell carcinoma
Serous carcinoma

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9
Q

Endometrial CA sx

A

Postmenopausal bleeding

Dysfunctional uterine bleeding (5% of endo CAs dx-ed

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10
Q

Name the types of endometrial hyperplasia from least risk of progression to CA to highest risk

A 
Simple hyperplasia without atypia
Complex hyperplasia without atypia
Simple atypical hyperplasia
Complex atypical hyperplasia
-These pts also have significant risk for concurrent endometrial adenocarcinoma
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11
Q

Genetic risk factors for endometrial CA

A

Lynch syndrome
Cowden syndrome
-Characteristic benign mucocutaneous hamartomas
-Uterine fibroids-40% of pts
-Increased endometrial, breast, thyroid, colorectal, and renal CAs

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12
Q

Screening and prevention of endometrial CA in pts with genetic RFs

A

Annual endometrial sampling and TVUS beginning at age 30-35
Risk-reducing hysterectomy
Oral contraceptives for possible chemoprevention

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13
Q

Endometrial CA workup

A

TVUS to evaluate endometrial lining

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14
Q

Endometrial CA: stage and spread at dx

A

Majority of uterine adenocarcinomas are dx-ed at early stage:

  • Confined to primary site (70%)
  • Spread to regional organs and lymph nodes (20%)
  • Distant metastases (10%)
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15
Q

Stage IA endometrial CA

A

Tumor confined to the endometrium

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16
Q

Stage IB endometrial CA

A

Invasion <1/2 myometrial thickness

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17
Q

Stage IC endometrial CA

A

Invasion >1/2 the myometrial thickness

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18
Q

Stage IIA endometrial CA

A

Endocervical glandular involvement only

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19
Q

Stage IIB endometrial CA

A

Cervical stromal invasion

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20
Q

Stage IIIA endometrial CA

A

Tumor invades serosa or adnexa, or malignant peritoneal cytology

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21
Q

Stage IIIB endometrial CA

A

Vaginal and/or parametrial metastasis

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22
Q

Stage IIIC1 endometrial CA

A

Metastasis to pelvic lymph nodes

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23
Q

Stage IIIC2 endometrial CA

A

Mets to P.A. nodes with or without pelvic lymph node metastasis

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24
Q

Stage IVA endometrial CA

A

Invasion of the bladder or bowel

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25
Stage IVB endometrial CA
Distant metastasis, including intra-abdominal or inguinal LNs
26
Tx of endometrial CA: surgical
Surgical tx includes: Peritoneal fluid cytology Abdominal exploration Pelvic and para-aortic lymphadenectomy Abdominal hysterectomy and bilateral salpingo-oophorectomy
27
Tx of endometrial CA: radiation and chemo
``` Commonly added for more advanced stage and high-risk features High-risk features include: Pathologic grade 3 Serous or clear-cell tumors Invasion of >1/2 the myometrium Extension to the cervix or adnexa ```
28
How are endometriosis and ovarian CA related?
They both involved the complement pathway Current genetic testing research aims to separate women with benign endometriosis with endometriosis-associated ovarian CA
29
Normal ovary size in premenopausal women
3.5 x 2 x 1.5 cm
30
Nl ovary size in pt 2-5 yrs after menopause
1.5 x 0.7 x 0.5 cm
31
What are u/s findings in ovaries that are suspicious for malignancy
Cystic mass vs solid Smooth capsule vs excrescences Presence of internal septa or papillae Presence of ascites is very suspicious for malignant process
32
Serum CA-125 and ovarian CA
Elevated in 80% of all pts with serous cystadenocarcinoma of the ovary but in only 50% of pts with stage I disease. Therefore not great for early dx and not for general screening. Used for monitoring response to therapy
33
Malignant adnexal lesions may be _____ or _______ dz from the uterus, breast, or gastrointestinal tract
Primary | Metastatic
34
PE of adnexal neoplasm
Cervical, supraclavicular, and/or inguinal LAD and/or the presence of pleural effusions or ascites Breast exam is especially important bc the ovary is a common site of metastasis from breast carcinoma
35
Serum CA-125 in benign conditions | Normal value
Rarely greater than 100 to 200 U per mL | <35 U/mL
36
Screening for ovarian CA
Do not screen women at average risk Screen women at increased risk- women with familial ovarian CA syndromes, who have not undergone prophylactic oophorectomy Screen with a combo of CA 125 and TVUS. Start at age 30 or 5-10 years earlier than the earliest age of 1st dx of ovarian CA in the family Screen every six months.
37
Human epididymis protein 4
An antigen derived from human epididymis protein, a product of the WFDC2 gene that is overexpressed in pts with serous and endometrioid ovarian carcinoma Used to monitor recurrent or progressive dz in pts with EOC
38
Lab reference range for human epididymis protein 4
Less than or equal to 150 pM
39
Types of epithelial ovarian CA from most common to least common
``` High-grade serous CA Endometrioid CA Clear cell CA Mucinous CA Low-grade serous CA ```
40
Epithelial ovarian carcinoma
CAs thought to arise from ovaries, but current thought is many of these CAs arise from Fallopian tubes or from Mullerian epithelium
41
Prevention of ovarian Ca in women with familial CA syndromes and genetic predispositions for ovarian CA
These women may have risk-reducing surgery-BSO or hysterectomy and BSO
42
Genetic mutations with increased risk of ovarian CA and other CAs
BRCA 1 and 2 gene mutations | Lynch syndrome
43
What is the risk for developing ovarian CA related to?
Cause is unknown Risk is related to parity The more children a woman has and the earlier in life she gives birth, the lower her risk of ovarian CA
44
Sx of ovarian CA- general
Often vague and non-specific Women and their doctors often blame the sx on other, more common conditions. Has usually spread beyond the ovaries by the time CA is dx-ed
45
Sx of ovarian CA- specific
``` Sense of pelvic heaviness Vague lower abdominal discomfort Vaginal bleeding Wt gain or loss Abnl menstrual cycles Unexplained back pain that worsens over time Increased abdominal girth Non-specific GI sx ```
46
Carcinosarcoma ovarian CA
Mean age dx 75 years | Histology is mixture of malignant epithelial and stromal tissues
47
Borderline/LMP ovarian CA
Termed semimalignant, good prognosis Surgery without chemo is current tx Age at dx tends to be around 10 yrs younger than the other epithelial ovarian CAs Serous and mucinous (serous more common) subtypes CA-125 not helpful in dx or f/u
48
Sex cord stromal tumors-ovarian CA
``` Composed of Granulosa cells Theca cells Sertoli cells Leydig cells Fibroblasts of stromal origin, single cell type or in various combinations CA-125 not useful in dx or f/u Chemo tx usually bleomycin, etoposide, and cisplatin ```
49
Granulosa-theca cell tumor
Often hormonally active and can produce large amounts of estrogen: pt may initially present with bleeding from endometrial hyperplasia
50
Cause of 1/3 of pts with Sertoli-Leydig tumors
``` Virilized from androgens and androgen precursors, causing: Oligomenorrhea Amenorrhea Breast atrophy Hirsutism Deepening voice Male pattern baldness Acne Clitoral enlargement ```
51
What are the most common malignant ovarian tumors in young women?
Dysgerminoma and immature teratoma
52
Tumor markers for ovarian CA germ cell tumor
LDH (best) HCG AFP
53
S/sx of ovarian germ cell tumor Prognosis Tx
Tend to occur in young women and girls: swelling, possible abd pain Curable if dx-ed and treated early Tx is surgery then chemo
54
Tx of ovarian CA
Surgical tx may be sufficient for malignant tumors that are well-differentiated (grade 1) and confined to the unruptured ovary (stage 1) Addition of chemo is required for more aggressive tumors (grade 2 or 3) that are confined to the ovary Pts with advanced disease (stage 2, 3, 4) standard of care is maximal cytoreductive surgery combined with multiagent chemo. Current favored regimen is carboplatin, Taxol, and Avastin
55
Stage I ovarian CA
Limited to one or both ovaries
56
Stage IA ovarian CA
Involves one ovary Capsule intact No tumor on ovarian surface No malignant cells in ascites or peritoneal washings
57
Stage IB ovarian CA
Involves both ovaries Capsule intact No tumor on ovarian surface Negative washings
58
Stage IC ovarian CA
Tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings
59
Stage II ovarian CA
Pelvic extension or implants
60
Stage IIA ovarian CA
Extension or implants onto uterus or fallopian tube | Negative washings
61
Stage IIB ovarian CA
Extension or impolants onto other pelvic structures | Negative washings
62
Stage IIC ovarian CA
Pelvic extension or implants with positive peritoneal washings

Women's Health Rotation (15 decks)

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