Uterine/Ovary/Cervical CA, Gestational Trophoblastic Disease (docs)

Question 1

What cell type is involved in uterine cervical carcinoma?

Answer 1

epithelial neoplasm, usually squamous cell carcinoma

Question 2

Epidemiology of uterine cervical carcinoma?

Answer 2

common

12,000 cases/yr

Question 3

Pathogenesis of uterine cervical carcinoma?

Answer 3

sexually transmitted HPV, especially 16 and 18

*only a tiny fraction of those infected get CA, and only after a long premalignant phase (as long as 20 years)

Question 4

Pathology of CIN-I?

Answer 4

koilocytotic atypia (large nuclei with a halo) correlated with viral replication

**now called LSIL

Question 5

Pathology of CIN-II?

Answer 5

pleomorphic atypia

Question 6

Pathology of CIN-III?

Answer 6

carcinoma in situ

Question 7

Symptoms/signs of uterine cervical carcinoma?

Answer 7

none, until late, when it starts bleeding

Question 8

Colposcopy results of CIN?

Answer 8

white patches after application of acetic acid

Question 9

Prognosis of uterine cervical carcinoma?

Answer 9

stage I: 85% 5-year survival
stage II: 75% 5-year survival
stage III: <50% 5-year survival

Question 10

Dx of uterine cervical carcinoma?

Answer 10

screen with pap

dx with biopsy

Question 11

HPV E6 gene product induces:

Answer 11

rapid degradation of p53 by ubiquitin-dependent proteolysis

Question 12

HPV E7 gene product complexes with:

Which causes:

Answer 12

hypophosphorylated active form RB protein

proteoysis of RB protein, removing its inhibition of S-phase entry (via binding E2F transcription factor)

Question 13

Colposcopy results of Invasive-type cervical ca?

Answer 13

fungating or flat or ulcerated,

commonly with highly abnormal vascular patterns

Question 14

Invasive cervical cancer occurs in patients ages:

Answer 14

40-45

Question 15

CIN III occurs in patients around age:

Answer 15

30

Question 16

Trx of HSIL (CIN-II/III)?

Answer 16

cryotherapy, laser, loop electrical excision procedure (LEEP), cone resection

Question 17

Trx of invasive cervical cancer?

Answer 17

hysterectomy and pelvic lymph node dissection

Question 18

Prevention of cervical cancer?

Answer 18

vaccine

Question 19

Ovarian carcinoma arises from:

Answer 19

surface of the ovary

Question 20

3 most common types of Ovarian carcinoma?

Answer 20

serous (75%)
endometrioid (10%)
mucinous (10%)

Question 21

Epidemiology of Ovarian carcinoma?

Answer 21

common
slightly more common in whites
average age at dx = 63

*progressive four-fold rise in incidence between age 40-49 and age >70

Question 22

Prognosis of Ovarian carcinoma?

Answer 22

depends on stage: 85% 5-year survival if confined to ovary, but 25% if spread

Question 23

Treatment of Ovarian carcinoma?

Answer 23

surgery (excision if confined to ovary, “debulking” if spread)
+/- chemotherapy

Question 24

Diagnosis of Ovarian carcinoma?

Answer 24

radiology (US or CT), then surgery with biopsy

Question 25

When does dx of Ovarian carcinoma usually occur?

Answer 25

Commonly late, after already metastatic

Question 26

Screening tests for Ovarian carcinoma?

Answer 26

none very good! | US, +/- serum CA-125

Question 27

When are serum screening tests for Ovarian carcinoma commonly +?

Answer 27

when tumor = already stage 3 **half of patients with stage 1 ovarian cancer have a normal CA-125 level

Question 28

Signs of Ovarian carcinoma?

Answer 28

``` *uncommon with early disease pelvic or abd mass abd ascites, tenderness groin LAD dec breath sound dullness to percussion over malignant pleural effusion ```

Question 29

Symptoms of Ovarian carcinoma?

Answer 29

``` bloating abdominal enlargement urinary symptoms abd pain pelvic pressure +++ ```

Question 30

In ovarian carcinoma, ___% have symptoms before diagnosis.

Answer 30

93

Question 31

Pathology of Ovarian carcinoma?

Answer 31

>60% distant metastases ~15% confined to 1' at dx typically 0.1-0.5 cm tumor nodules all over peritoneum and omentum

Question 32

Spread of Ovarian carcinoma?

Answer 32

first to peritoneum | then other ovary, regional lymph nodes, liver, lungs, etc

Question 33

Pathogenesis of Ovarian carcinoma?

Answer 33

accumulation of mutations in genes controlling cell proliferation (usually over many years)

Question 34

Risk factors for Ovarian carcinoma?

Answer 34

- -age - -high exposure to gonadotropins - -high freq of ovulation (?) - -few or no pregnancies - -early menarche, late menopause - -family history (*BRCA mutation) - -smoking (mucinous type only)

Question 35

Conditions (risk factors) related to ovarian cancer?

Answer 35

- -obesity (30% increased risk) | - -endometriosis (2.5 % lifetime risk)

Question 36

types of endometrial carcinoma?

Answer 36

type 1 = endometrioid (grade 1 or 2) **80% type 2 = endometrioid (grade 3), serous or mucinous (etc) **20%

Question 37

Epidemiology of endometrial carcinoma?

Answer 37

US women have 2.6% lifetime risk | Average age at diagnosis = 61

Question 38

Pathogenesis of endometrial carcinoma?

Answer 38

type 1 = estrogen-responsive | type 2 = not estrogen-responsive

Question 39

Risk factors for type 1 endometrial carcinoma?

Answer 39

``` age obesity unopposed estrogen tamoxifen nulliparity DM HTN polycystic ovarian syndrome ```

Question 40

Genetic abnormalities in endometrial carcinoma?

Answer 40

Loss of PTEN function = early event loss of p53 = 1' genetic defect in non-endometrioid endometrial CA

Question 41

Pathology of endometrial carcinoma?

Answer 41

68% confined to uterus at dx 20% uterus + lymph nodes 8% + distant metastases

Question 42

Location of recurrences of endometrial carcinoma?

Answer 42

vaginal vault > pelvis > abdomen or lungs

Question 43

Symptoms of endometrial carcinoma?

Answer 43

abn uterine bleeding = cardinal symptom

Question 44

Signs of endometrial carcinoma?

Answer 44

typically none (uterus is usually not enlarged on exam)

Question 45

Dx of endometrial carcinoma?

Answer 45

can sometimes be made on cytology, but usually requires biopsy

Question 46

Treatment of endometrial carcinoma?

Answer 46

type 1: hysterectomy alone type 2: hysterectomy +/- chemotherapy +/- radiation

Question 47

Prognosis of endometrial carcinoma?

Answer 47

cancer confined to uterus at dx = 96% 5-year survival distant mets = 26% 5-year survival

Question 48

Most recurrences of endometrial carcinoma are in the first ___ years

Answer 48

three