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GU / GYN & Renal > Clinical: Gynecologic Oncology > Flashcards

Clinical: Gynecologic Oncology Flashcards

1
Q
  • Majority of ovarian cancers: 95%
  • Average age at Dx: 63 years
  • Most aggressive form of ovarian cancer

Epidemiology

A

Ovarian carcinoma

High-grade serous carcinona = most aggressive ovarian cancer

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2
Q
  • 25% of all ovarian neoplasms; only 1% of cancers
  • Account for 70% of ovarian tumors in ages 1-20

Epidemiology

A

GCT

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3
Q
  • Account for 3% of all ovarian cancers
  • Average age at Dx: 40s

Epidemiology

A

Sex cord-stromal cancers

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4
Q

TP53 mutation

Genetic Abnormalities

A

Associated with high-grade ovarian serous carcinoma, endometrial serous carcinoma

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5
Q

Inactivation of BRCA1/2

Genetic Abnormalities

A

Associated with high-grade ovarian serous carcinoma

Inactivation: mutation or hypermethylation

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6
Q

KRAS mutation

Genetic Abnormalities

A

Associated with low-grade ovarian serous carcinoma, ovarian mucinous carcinoma, endometrial endometrioid carcinoma

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7
Q

BRAF mutation

Genetic Abnormalities

A

Associated with ovarian mucinous carcinoma

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8
Q

PIK3CA mutation

Genetic Abnormalities

A

Associated with low-grade ovarian serous carcinoma, ovarian endometrioid carcinoma, ovarian clear cell carcinoma, endometrial carcinoma (types 1 & 2)

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9
Q

ARID1A mutation

Genetic Abnormalities

A

Associated with ovarian endometrioid carcinoma, ovarian clear cell carcinoma

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10
Q

PTEN mutation

Genetic Abnormalities

A

Associated with ovarian endometrioid carcinoma, endometrial endometrioid carcinoma

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11
Q
  1. Advancing age
  2. Obesity
  3. Nulliparity
  4. Endometriosis
  5. Early menarche / late menopause
  6. Genetic factors
A

Ovarian cancer

Risk Factors

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12
Q
  • 40% lifetime risk of ovarian cancer
  • 60-80% lifetime risk of breast cancer

Risk Factors: Genetic

A

Inactivation of BRCA1

Chromosome 17

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13
Q
  • 20% lifetime risk of ovarian cancer
  • 60-80% lifetime risk of breast cancer

Risk Factors: Genetic

A

Inactivation of BRCA2

Chromosome 13

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14
Q
  • Increased risk of colon cancer
  • 60-80% lifetime risk of endometrial cancer
  • 10% lifetime risk of ovarian cancer (10%)

Risk Factors: Genetic

A

Lynch syndrome / HNPCC

HNPCC: hereditary non-polyposis colorectal cancer

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15
Q
  1. Oral contraceptive pills
  2. Multiparity
  3. Lactation
  4. Tubal ligation
  5. Opportunistic salpingectomy
A

Ovarian cancer

Protective Factors

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16
Q
  • Bloating
  • Abdominal pain
  • Weight changes
  • Early satiety
  • Changes in stool caliber
  • Constipation
  • Vaginal discharge

Symptoms

A

Ovarian cancer

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17
Q

Endometriosis

Risk Factor

A

Increased risk: clear cell ovarian cancer; endometrioid ovarian cancer

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18
Q

LDH

Markers

A

Dysgerminoma

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19
Q

Schiller-Duval bodies

Histological Hallmarks

A

Endodermal sinus tumor

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20
Q

AFP

Markers

A
  • Endodermal sinus tumor
  • Embryonal carcinoma
  • Immature malignant teratoma
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21
Q

B-hCG

Markers

A

Choriocarcinoma

Syncytioblasts produce B-hCG

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22
Q

Most common malignant GCT
* Most common in women age < 30
* Bilateral: 15-20% of cases

Epidemiology

A

Dysgerminoma

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23
Q

Most common ovarian GCT
* Bilateral: 12% of cases

A

Mature cystic teratoma (dermoid cyst)

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24
Q

Most common ovarian GCT
* Bilateral: 12% of cases

A

Mature cystic teratoma

25
Q

Carl-Exner bodies

Histological Hallmarks

A

Granulosa cell tumor

26
Q

Granulosa cell tumor

Risk Factor

A

Increased risk for endometrial carcinoma (10%)

Due to estrogenic effects

27
Q

FOXL2 mutation

Genetic Abnormalities

A

Associated with granulosa cell tumor

28
Q

Inhibin B

Markers

A

Granulosa cell tumor

29
Q
  • Lymphocytic infiltrate
  • Multinucleated giant cells

Histological Hallmarks

A

Dysgerminoma

30
Q

Coffee bean nuclei

Histological Hallmarks

A

Granulosa cell tumor

31
Q

Reinke crystals

Histological Hallmarks

A

Leydig cell tumor

32
Q

Rokitansky’s tubercle

Histological Hallmarks

A

Mature cystic teratoma (dermoid cyst)

33
Q

Psammoma bodies

Histological Hallmarks

A

Ovarian papillary serous carcinoma

34
Q

Hobnail cells

Histological Hallmarks

A

Ovarian clear cell carcinoma

35
Q

Ovarian mucinous carcinoma

Associations

A

Associated with pseudomyxoma peritonei

36
Q

MLH1 mutation

Genetic Abnormalities

A

Associated with HNPCC

MLH1: DNA MMR gene

37
Q

MSH2 mutation

Genetic Abnormalities

A

Associated with HNPCC

MSH2: DNA MMR gene

38
Q
  1. Obesity
  2. Genetic syndromes (e.g., Lynch)
  3. Endometrial hyperplasia
  4. Tamoxifen use
A

Endometrial cancer

Risk Factors

39
Q
  1. Smoking
  2. Combined oral contraceptive
  3. Intrauterine contraceptive device
A

Endometrial cancer

Protective Factors

40
Q

MSI mutation

Genetic Abnormalities

A

Associated with endometrial cancer

41
Q
  • Accounts for 80% of uterine cancers
  • Clinical setting: excess unopposed estrogen & endometrial hyperplasia
  • Well-differentiated / low-grade
  • Favorable prognosis

Epidemiology

A

Type 1 endometrial carcinoma: endometrioid

42
Q
  • Accounts for 20% of uterine cancers
  • Non-estrogen dependent
  • Clinical setting: atrophic endometrium or polyps
  • Poorly-differentiated / high-grade
  • Poor prognosis

Epidemiology

A

Type 2 endometrial carcinoma: papillary serous, clear cell or carcinosarcoma (MMMT)
* High-risk histologies

MMMT = malignant mixed mesodermal tumor

43
Q

Uterine tumor containing a malignant epithelial component & a malignant mesenchynal component

Pathology

A

Carcinosarcoma (MMMT)

44
Q

Atypical endometrial hyperplasia

Treatment

A
  • Fertility-sparing: progesterone; oral, Mirena IUD
  • Non-fertility sparing: simple hysterectomy
45
Q

Related to high-risk HPV infection
1. Early onset of sexual activity
2. Multiple / high-risk sexual partners
3. History of STIs
4. Immunosuppression
5. History of VIN / VAIN
6. Smoking

A

Cervical cancer

Risk Factors

46
Q
  • Associated with high-risk HPV infection
    • Risk factors: smoking; immunosuppression
    • HPV-16 most common
  • More common in younger women: 40s-50s
  • Progresses to warty & basaloid carcinoma
    • High-grade
    • Long time to progression

Epidemiology

A

VIN, usual type

47
Q
  • Often associated with lichen sclerosis
    • 5% of LS will develop SCC within 10 years
    • Usually not associated with HPV infection
  • More common in older women: 70s
  • Progresses to invasive SCC
    • Well-differentiated
    • Short time to progression
A

Differentiated VIN

VIN, keratinizing type

48
Q

Vulvar Paget’s Disease

Treatment

A

Wide local excision

49
Q

Drains to inguinal lymph nodes first, followed by pelvic lymph nodes

Pathology

A

Vulvar cancer

50
Q

Early stage vulvar cancer

Treatment

A

Vulvectomy with lymph node dissection (LND)

51
Q

VIN

Treatment

A

Wide local excision

52
Q

Most common site of extramammary Paget’s disease

Epidemiology

A

Vulva

53
Q

2nd most common vulvar malignancy

Epidemiology

A

Vulvar melanomoa

54
Q

Most common finding in vulvar melanoma

Epidemiology

A

Pigmented lesion

55
Q
  1. Asians
  2. Diet low in animal fat, carotene, Vit A
  3. Extremes of reproductive years
  4. History of infertility / many abortions
  5. Blood type A / AB
A

Gestational trophoblastic disease

Risk Factors

56
Q

HPL

Markers

A

Gestational trophoblastic neoplasia (GTN)

57
Q

Low-risk GTN

Approach to Therapy

A

Single agent CTX w/ methotrexate or actinomycin D
* If no response to MTX, can switch to act-D
* Rx for GTD if pt. has renal insufficiency: act-D

58
Q

High-risk GTN or choriocarcinoma

Approach to Therapy

A

Multi-agent CTX w/ EMA-CO
* E = etoposide
* M = methotrexate
* A= actinomycin D
* C = cyclophosphamide

59
Q

GTD

Approach to Therapy

A

Surgical: D&C

GU / GYN & Renal (23 decks)

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