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Repro. Med 3 > Upper Genital Tract Malignancies > Flashcards

Upper Genital Tract Malignancies Flashcards

1
Q

Unopposed estrogen can cause ___ CA
Frequent ovulation can cause __ CA
There is a Genetic predisposition for ___ and ___ CA

A

Endometrial CA
Ovarian CA
Fallopian tube / ovarian CA

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2
Q

____ is the most frequent gyn CA in the US

A

Endometrial CA

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3
Q

What is the median age for endometrial CA?

___% are dx < 45 y/o

A

61 y/o

8%

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4
Q

What are causes of unopposed estrogen?

A 
OBESITY!
Nulliparity
Oligo-menorrhea
Late menopause
Estrogen-only meds
Estrogen-producing tumor
Tamoxifen
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5
Q

What hereditary factors can put a pt at risk for endometrial CA?

A

Lynch II syndrome (uterus, ovary, breast, colon)

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6
Q

How can you prevent endometrial CA?

A

Establish regular cycles
OCPs
Avoid estrogen-only replacement
Avoid obesity

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7
Q

Is type I endometrial CA hormone dependent or independent? What grade(s) is it on histology?

Is it early/advanced stage?

Does it have a good/bad prognosis ?

A

Hormone-dependent
Endometroid grade I and II histology

Early stage

Good Prognosis

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8
Q

Is type II endometrial CA hormone dependent or independent? What grade(s) is it on histology?

Is it early/advanced stage?

Does it have a good/bad prognosis ?

A

No hormonal influences
endometroid grade III, papillary serous and clear cell histology

Advanced stage

Poor prognosis

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9
Q

What are the most common pathology types for endometrial CA? Percentages?

A

Adenocarcinoma - 60%

Adenoacanthoma - 22%

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10
Q

What is the 5-yr survival rates (%) for the following Endometrial CA grades?

Grade I (<5% solid) \_\_\_\_
Grade II (5-49% solid) \_\_\_\_\_
Grade III (>50% solid) \_\_\_\_\_

Localized ___
Regional ___
Distant___

A 
Grade I (<5% solid)	  80%
Grade II (5-49% solid)	73%
Grade III (>50% solid)	59%

Localized 95%
Regional 67%
Distant 16%

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11
Q

What are sx of endometrial CA?

What signs are rarely present?

A

Postmenopausal bleeding
Brownish discharge
Irregular bleeding and spotting

Rarely signs of dissemination such as pain, mass, ascites

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12
Q

What age is endometrial CA most common?

A

60% >80 y/o

28% 70-79 y/o

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13
Q

How do you dx endometrial CA?

A

Bx
US
Hysteroscopy
D and C

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14
Q

What is included in the pre-tx w/u for endometrial CA? (imaging, etc)

A

Mainly assess risk for surgery

  • CXR
  • CT scan
  • MRI if surgery not possible
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15
Q

How do you tx endometrial CA?

A 
TAH/BSO +/- staging
Radiation to the vaginal cuff
External radiation
Chemotherapy
Progestational agents
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16
Q

What are the benefits of pelvic lymphadenectomy?

A

Detection of nodal metastasis

Individualized tx planning

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17
Q

What are the cons of pelvic lymphadenectomy? (FYI)

A

Risk of surgery,
Risk of lymphedema, lymphocyst
No definite survival benefit

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18
Q

What are the 3 types of uterine sarcomas? % distribution of each?

A

Leiomyosarcoma (16%)
Endometrial stromal sarcoma (44%)
Mixed mesodermal sarcoma (40%)

19
Q

T/F: Uterine sarcomas are common

A

F: they are RARE

20
Q

Are Asians/Whites/African Americans more likely to have uterine sarcoma?

A

African American women

21
Q

Sx of uterine CA are similar to those of ___ CA

A

Endometrial CA

22
Q

Uterine sarcomas are ___ tumors w/ a high risk of ____.
There is a ___ response rate to tx.
Stage 1 dz has a survival rate of ___%

A

aggressive; distant metastasis
Low
50%

23
Q

What are the types of ovarian tumors? (x8+)

A

Brenner
Endometrioid
Mucinous

Serous
Clear cell
Undifferentiated
Mixed (Types: Benign/Borderline/Malignant) 
Mixed mesodermal tumors

(BEM SCUMM)

24
Q

Fallopian tube CA originates mainly in the ____.
Tissue transfer to the ovary at time of ovulation can cause ___ CA.
Fallopian tube CA is clinically similar to ___ CA.

A

fimbriae
ovarian
ovarian

25
Q

Adenocarcinoma of the peritoneum originates from ___ and ____.
Clinically similar to _____ CA, the largest tumor volume is often in the ____.

A

endometriosis
endosalpingiosis

ovarian
omentum

26
Q

Ovarian CA causes __% of gyn CA, but cause __% of gyn CA deaths.

Median age is __ y/o, ___% < 45 y/o

A

23%
47%

63 y/o
11%

27
Q

What are the RF for ovarian CA? (x8)

A

FHx, frequent ovulation, low parity, caucasian, high fat/low fiber diet, talc exposure, living in northern countries, high SES

28
Q

What is your risk of ovarian CA if you have the BRCA 1 mutation? (%)
What other malignancies may you be at risk for? (%)

A

BRCA 1: 40-46%

Breast CA: 50-85%

29
Q

What is your risk of ovarian CA if you have the BRCA 2 mutation?
What other malignancies may you be at risk for?

A 
10-20% 
Breast CA (40-85%)
30
Q

What is your risk of ovarian CA if you have lynch syndrome?

What other malignancies may you be at risk for?

A

9-12%

Colon CA 30-54%
Uterine CA 40-60%

31
Q

Oral contraceptiive can reduce risk of ovarian CA in pts with ____, ____, or the ____.

A

Nulliparity (after 5 yrs of use)
Positive FHx (after 10 yrs of use)
BRCA mutation

32
Q

T/F: General screening for ovarian CA is not recommended due to low prevalence

A

T

33
Q

If you have a (+) FHx for ovarian CA: what age should you be screened and what are the screening exams?

If a pt has Hereditary Ovarian CA, what age should they be screened? What are the screening exams?

A

Age 30-35 y/o

  • pelvic exam
  • CA 125
  • US

Age 25: (as above)
- consider BSO or at least salpingectomy

34
Q

What are ovarian CA warning signs?

A

Ill-defined GI complaints
Early satiety
Abdominal distention and bloating (For >12 days/mo)
Persistent pelvic pain in a postmenopausal pt

35
Q

How do you dx ovarian CA?

A 
General PE
Pelvic exam
CA 125 level, OVA 1, CEA,
Pelvic US
CT abdomen and pelvis
CXR
36
Q

what are the 2 types of low malignant potential ovarian tumors?

A

Epithelial “borderline” tumors

Stromal

37
Q

If ovarian CA is suspected, surgery (mainstay) allows for __ and ___

A 
Dx 
Surgical staging (ctyology, peritoneal bx, lymphadenectomy)
38
Q

Tumor Reductive Surgery can be used in ovarian CA and If adequate, it can Lead to ____

A

Survival benefit

39
Q

What are post-op tx for ovarian CA?

A

Systemic chemotherapy

Intraperitoneal therapy

40
Q

Intra-peritoneal chemotherapy is delivered through an ___ port.
What are the pros? Cons?

A

IP
Pros: improved overall survival
Cons: difficult to administer, more side effects

41
Q

PARP Inhibitors have the best effect if the pt has a germ line or tumor ___ mutation

A

BRCA

42
Q

What are prognostic factors for ovarian CA?

A

Time to recurrence

Response to platin compounds

43
Q

What is the 5 yr survival rate for the following with ovarian CA? (FYI)
localized ___ %pts ___ 5 yr survival
regional ___ %pts ___ 5 yr survival
distant ___ %pts ___ 5 yr survival

A

localized: 15%; 91%
regional: 17%; 72%
distant: 61%; 27%

Repro. Med 3 (14 decks)

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