10. Neoplasms Flashcards
Typical endometrial patient characteristics
Post menopausal bleeding; Nulliparious; High BMI; FH of colon CA; Possible PCOS
What cancer is most closely linked to obesity?
Endometrial cancer
Sentinel sx of endometrial CA
Postmenopausal bleeding
Most effect tx for endometrial CA
Surgery;
2nd line tx for endometrial CA
Radiation & chemo; Metformin is targeted tx
What is the MoA of Metformin in endometrial CA?
PTEN pathway, which is abnormal in almost all endometrial CA
3rd line tx for endometrial CA
Progesterone-only HRT
What tx is preferred for elderly pts with endometrial CA?
Hormonal
Why would progesterone tx be preferrable for young woman with endometrial CA?
Preserves reproductive organs
Tumor suppressor genes MLH1, MSH2,PMS2, and MSH6 are associated with what syndrome?
Lynch syndrome
What cancers are most common with Lynch syndrome?
Colon & endometrial cancers are most common. Lifetime risk of developing one is 80%.
Is Lynch syndrome a dominant or recessive inheritance?
Dominant
When is prophylactic hysterectomy and oophorectomy recommended?
Lynch syndrome after age 35 or once childbearing is complete
When should Lynch syndrome patients begin colorectal cancer screening? How frequently?
Colonoscopy q1-2 yrs starting at 20-25
When should Lynch syndrome patients begin endometrial biopsy screening? How frequently?
Annually beginning at age 30-35
When is the most common type of endometrial cancer?
Endometrioid endometrial CA
What are the most aggressive endometrial CA types?
Serous & clear cell (not well-understood)
When is ovarian cancer most commonly found?
Stage 3 or 4
What is the cure rate when ovarian cancer is commonly found?
30%
Typical ovarian CA patient characteristics
Postmenopausal; Nulliparious; IBS; FH of Breast CA
Ovarian CA tx
Surgery (aggressive debulking) + Chemo (taxane & platinum) via intraperitoneal route + Targeted therapy
When is surgery contraindicated in ovarian CA?
If pt isn’t willing to take chemo.
What is the relapse rate of ovarian CA?
75%
What is one of the most chemo-sensitive cancers?
Ovarian
What chemo agents are used in recurrent ovarian CA?
Bevacizumab (Avastin) & PARP inhibitor olaparib
Role of radiation in ovarian ca?
Palliative care
What cultural group is at highest susceptibility to BRCA1/2 mutations?
Ashkenazi Jews
What effect do OCPs have on ovarian cancer?
50% reduction after 5 yrs of use
What is the ovarian cancer risk reduction is offered by tubal ligation and hysterectomy?
30-50%
What is the gold standard in ovarian CA prevention?
Bilateral salpho-oophorectomy (Upto 95% reduction); Also decreases Breast CA risk by 50%
What percentage of women with ovarian cancer receive standard of care tx?
Characteristics of cervical CA patients
Postcoital bleeding; Smoker; NL BMI; no GYN care
Cervical CA dx - Most common stage
Stage 1
What chemotherapy agents are used in cervical cancer tx?
Bevacizumab (Avastin) for recurrent dz
Stage IA cervical CA surgery
Cone bx vs. simple hysterectomy
Stage IB cervcial CA surgery
Radical hysterectomy/LND
When is surgery no longer a tx option for cervical CA?
Stages beyond 1B not surgical candidates
When is exenteration indicated?
Palliative care for recurrent cervical cancer
What is the most effective cancer screening tool?
PAP
Can you contract HPV from the vaccine?
No. It contains no virus DNA or RNA.
