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Class 6 Flashcards

1
Q

True or False: In past decades cervical carcinoma was more common than endometrial carcinoma worldwide

A

True

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2
Q

True or False: In USA, endometrial carcinoma is more common than Cervical Carcinoma

A

True

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3
Q

Why is Cervical Carcinoma more common in USA than endometrial carcinoma?

A
  • Early diagnosis of cervical CA with PAP smear and cone biopsy
  • Increased patient life span
  • Postmenopausal estrogen use
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4
Q

What are risk factors for development of endometrial carcinoma?

A
  • OBESITY
  • DIABETES
  • HIGH BLOOD PRESSURE
  • SHORT IN HEIGHT
  • JEWISH
  • AGE (postmenopausal)
  • ESTROGEN USE AFTER MENOPAUSE
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5
Q

What are some of the effects of endometrial carcinoma?

A
  • Dysfunctional uterine bleeding without ovulation
  • Hyperplasia of the endometrium
  • Polycystic ovaries (Stein-Leventhal Syndrome)
  • Theca Granulosa Cell tumor
  • Tamoxifen use for breast cancer
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6
Q

Where does endometrial carcinoma begin? Where does it grow to?

A

It begins in the endometrium then grows toward the myometrium

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7
Q

True or False. The greater degree of infiltration of endometrial carcinoma into the myometrium, the GREATER the prognosis

A

False: The greater degree of infiltration of endometrial carcinoma into the myometrium, the POORER the prognosis

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8
Q

What determines the STAGE of endometrial carcinoma?

A

The degree of tumor spread

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9
Q

What determines the GRADING of endometrial carcinoma?

A

The Tumor differentiation

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10
Q

What are the signs and symptoms of Endometrial Carcinoma?

A
  • Bleeding or discharge after menopause

- PAIN

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11
Q

What are some treatment options for Endometrial Carcinoma?

A
  • Complete hysterectomy with bilateral oophorectomy
  • Lymphadenectomy
  • Pre or Post Operative radiation therapy
  • Chemotherapy
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12
Q

US appearance of Endometrial Carcinoma

A
  • Uterus may appear normal
  • Uterus may be increased in size
  • Endometrium may be thickened
  • Endometrial cavity may be fluid filled
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13
Q

What are some of the differential diagnoses for Endometrial Carcinoma?

A
  • ENDOMETRIAL HYPERPLASIA
  • ENDOMETRIAL POLYPS
  • LEIOMYOMA
  • CERVICAL CARCINOMA (causing hematometra or pyometra)
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14
Q

True or False: Leiomyosarcoma is the MALIGNANT counterpart of Fibroid

A

True

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15
Q

Is Leiomyosarcoma common or rare? What is the percentage of uterine tumors?

A

Rare and 3% of uterine tumors

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16
Q

If a fibroid has a growth spurt, what malignancy is suspected?

A

Leiomyosarcoma

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17
Q

What age is Leiomyosarcoma most common?

A

50’s

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18
Q

Can an Ultrasound distinguish leiomyoma from Leiomyosarcoma?

A

No

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19
Q

True or False: On an ultrasound a Leiomyosarcoma may present as inhomogeneous uterine mass with areas of cystic degeneration

A

True

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20
Q

What are some risk factors for Cervical Carcinoma?

A
  • EARLY SEXUAL ENCOUNTERS
  • MULTIPLE SEXUAL PARTNERS
  • INFECTION BY STD OR A SEX PARTNER WHO HAS AN STD
  • HUMAN PAPILLOMA VIRUS (causes genital warts)
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21
Q

What is the most common cell type for Cervical Carcinoma?

A

Squamous cells

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22
Q

True or False: The prognosis for Cervical Carcinoma does not depend on the stage at diagnosis

A

False: PROGNOSIS DEPENDS ON STAGE AT DIAGNOSIS

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23
Q

True or False: In Cervical Carcinoma metastases is via Lymphatic system of pelvis

24
Q

What is the staging of Cervical Carcinoma?

A

STAGE 1 - confined to cervix
STAGE 2 - spread to vagina, upper cervix, and parametrium
STAGE 3 - spread to lower portion of vagina and to pelvic wall
STAGE 4 - extends beyond true pelvis, bladder and/or rectal involvement, mets to distant organs (lung, bone, and liver)

25
Q

What are the signs and symptoms of Cervical Carcinoma?

A
  • ABNORMAL PAP SMEAR
  • VAGINAL DISCHARGE
  • INTERMITTENT BLEEDING (especially after intercourse)

MORE ADVANCED STAGES:

  • Bladder irritability
  • Back pain
  • Ureteral obstruction
26
Q

What are some treatment options for Cervical Carcinoma?

A 
-SURGICAL
or
DEPENDANT UPON THE STAGE OF DISEASE
-CONE BIOPSY
-RADICAL HYSTERECTOMY
-RADIATION THERAPY
-CHEMOTHERAPY
27
Q

Ultrasound Appearance of Cervical Carcinoma?

A

Stage 1 OR 2

  • May be no change in cervical appearance
  • Cervix may appear bulky or irregular
  • Cervix may exhibit changes in echogenicity
  • Hematometra or pyometra may be present due to cervical stenosis
28
Q

What are some of the differential diagnoses for Cervical Carcinoma?

A
  • LEIOMYOMA INVOLVING THE CERVIX
  • ENDOMETRIAL CARCINOMA INVOLVING THE CERVIX
  • ENDOMETRIAL POLYPS PROLAPSED INTO THE VAGINA
29
Q

What causes Gestational Trophoblastic Disease?

A

Abnormal Proliferation of the Trophoblast: supplying the embryo with nourishment and later forming the major part of the placenta

30
Q

What are the three types of Gestational Trophoblastic Disease?

A
  • HYDATIFORM MOLE - benign trophoblastic disease
  • INVASIVE MOLE (CHORIOADENOMA DESTRUENS) - malignant nonmetastatic trophoblastic disease
  • CHORIOCARCINOMA - malignant metastatic trophoblastic disease
31
Q

True or False: 1 in 100 pregnancies in US and Europe result in Hydatiform Mole

A

False: 1 in 1000 pregnancies in US and Europe result in a Hydatiform Mole
The highest incidences are in Far East and Asia

32
Q

What are some of the Risk factors for Gestational Trophoblastic Disease?

A
  • AGE (OVER 40YEARS OR UNDER 20 YEARS)
  • PREVIOUS MOLAR PREGNANCY
  • BLOOD TYPE
  • BIRTH CONTROL PILLS
  • NUMBER OF SEXUAL PARTNERS
  • SOCIOECONOMIC
33
Q

What are the 2 types of Hydatiform Mole?

A

Complete and Incomplete

34
Q

What is a COMPLETE Hydatiform Mole?

A
  • Fertilization of defective ovum by single sperm that duplicates
  • Fertilization of one ovum by two sperm
  • Higher malignant potential
  • Hydropic degeneration and swelling of the chorionic villi
  • Proliferation of the trophoblast
  • Absence of fetus and amnion
35
Q

What is an INCOMPLETE Hydatiform Mole?

A
  • Fertilization of a normal egg by two sperm
  • Fertilization of a normal ovum by a sperm with a diploid set of chromosomes
  • Focal and less advanced hydatiform changes
  • Some villi spared and not others
  • Fetus, fetal parts, or amniotic sac rarely present
36
Q

A Theca Lutein Cysts is found in 20-30% of patients with what kind of pregnancy?

A

Molar Pregnancy

37
Q

What is a molar pregnancy?

A

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term.

38
Q

What is the cause of Theca Lutein Cysts?

A

Elevated levels of Human chorionic gonadotropin (hCG)

39
Q

True or False: Theca Lutein Cysts are unilateral

A

False: They are Bilateral

40
Q

True or False: Theca Lutein Cysts are prone to hemorrhage

41
Q

How long after the evacuation of the uterus will a Theca Lutein Cyst remain?

A

2-4 Months

42
Q

What is Gestational trophoblastic disease (GTD)?

A

Gestational trophoblastic disease (GTD) is a group of pregnancy-related conditions that develop inside a woman’s uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops during pregnancy to feed the fetus.

43
Q

What are the signs and symptoms of Gestational trophoblastic disease (GTD)

A
  • IRREGULAR VAGINAL BLEEDING DURING PREGNANCY
  • DISCREPANT UTERINE HEIGHT
  • HYPEREMESIS
  • PREECLAMPSIA
44
Q

Lab findings for Gestational trophoblastic disease (GTD)?

A

ELEVATED SERUM hCG
>100,000mIU/ml
Triple the normal level
Continue to rise 100 days after LMP

45
Q

US Findings in 1st trimester for Gestational trophoblastic disease (GTD)

A
  • Blighted ovum
  • Missed abortion
  • Degenerating leiomyoma
  • Hydropic placenta
  • Endometrial cancer
  • Adenomyosis
46
Q

US Findings in 2nd trimester for Gestational trophoblastic disease (GTD)

A
  • Soft tissue mass with sonolucent areas of different sizes
  • “snow flake or lacey pattern”
  • Absence of fetal parts
  • Myometrium may appear hypoechoic
  • Uterus large for dates
  • Bilateral theca lutein cysts may be present
47
Q

What is an invasive mole?

A

Invasive mole is a tumorous growth associated with gestation and falls under the spectrum of gestational trophoblastic disease

48
Q

Chorioadenoma Destruens is also known a?

A

Invasive Mole

49
Q

True or False: Invasive moles are Malignant non-metastatic trophoblastic diseases that are a progression of a benign disease

50
Q

What percentage do invasive moles occur?

A

15-18% of cases

51
Q

Invasive moles penetrate and invade what area?

A

the Myometrium

52
Q

If elevated levels of hCG are present, what is the suspected reason?

A

Invasive Mole

53
Q

Ultrasound Appearance of an invasive mole

A 
Cannot distinguish from benign condition
Enlarged uterus
Cystic spaces of varying sizes 
Echogenic areas within uterus
Diagnosed after hysterectomy with examination of myometrium
54
Q

What is Choriocarcinoma?

A

Choriocarcinoma is a fast-growing cancer that occurs in a woman’s uterus (womb)

Malignant Metastatic Trophoblastic Disease

55
Q

What percentage of Hydatiform moles become choriocarcinoma?

56
Q

Choriocarcinoma develops from 1/2 ______ and another 1/2 ______

A
  • 1/2 DEVELOP FROM MOLAR PREGNANCY

- 1/2 DEVELOP FROM NORMAL PREGNANCY, ECTOPIC OR MISCARRIAGE

57
Q

Molar Pregnancy Treatment

A
  • Surgery
  • Radiation
  • Chemotherapy

Ultrasound OBGYN (9 decks)

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