Week 11: Gynecologic malignancies Flashcards
Name risk factors for endometrial cancer
-Obesity
-chronic anovulation, excess estrogen
-Tamoxifen
-Infertility
-Early menarche, late menopause
-Atypical endometrial hyperplasia (pre-endometrial ca. If found, ~30% risk of ca)
Describe the diagnosis and screening recommendations for endometrial ca
-Screening: none of gen pop
-Diagnosis: exam, transvaginal US often used, endo biopsy or D&C
Name the three subtypes of endometrial cancer
-Epithelial (90%)
-Carcinosarcoma: features of both epithelial and sarcoma
-Sarcoma (<5%)
Compare the two subtypes of epithelial endometrial ca
Type I (75-80%)
-Estrogen related
-Low grade
-Favorable prognosis
-Somatic mutations: PTEN, CTNNB1, PIK3A, KRAS
Type II (10-15%)
-Estrogen unrelated
-High grade
-Poor prognosis
-Somatic mutations: P53
What is a hot vs cold tumor
(endo cancer)
Hot
-High mutational burden=lots of immunotherapy targets
-POLE-mutated (excellent prognosis) and MSI hypermutated (intermediate prognosis)
Cold
-Low mutational burden=few immunotherapy targets
-Copy number low (variable prognosis), copy number high (poor prognosis)
What germline variants are associated with endometrial cancer?
PTEN, MLH1, MSH2, MSH6, EPCAM, PMS2
-Screening: Endometrial biopsy every 1-2 yrs considered
-Recommend for hysterectomy +/- BSO
Name cervical cancer risk factors
-Persistent infection with high-risk HPV subtypes
-High grade cervical dysplasia
-Smoking (changes cervical environment so it’s more hospitable to HPV)
-Immunosuppression
Name risk factors that increase and risk factors that decrease risk for ovarian ca
Increase
-Age
-Family hx
-Infertility/low parity
-Personal ca hx
Decrease
-Oral contraceptive use
-Pregnancy and breastfeeding
-Tubal ligation
-Hysterectomy/removal of ovaries
Name the two subtypes of ovarian ca
-Epithelial (90%): derived from surface epithelium
-Nonepithelial (10%): derived from other parts of the ovary, generally affect younger women or adolescents in the case of germ cell tumors
What is a STIC lesion
A pathologic finding of unclear clinical significance, possibly a precursor lesion for high-grade pelvic serous carcinoma arising from distal end of fallopian tube
List all the genes that when an individual is found to have a pathogenic variant in, RRSO is recommended 45-50yr
BRIP1
PALB2
RAD51C
RAD51D
MLH1
MSH2
MSH6
EPCAM
BRCA2
BRCA1 (35-40)
List risk factors for vulvar cancer
-Smoking
-Immunosuppression
-HPV
-Hx of cervical cancer/HPV
-Vulvar dystrophy: lichen sclerosis
-Hx of vulvar intraepithelial neoplasia (VIN)
-Age >70
-Low SES
What is the least common gyn cancer
vaginal cancer
<1 case per 100,000 women
How is vulvar cancer treated typically
Radiation therapy
Surgery sometimes but not great margins
