Clinical - Uterus Carcinoma

Question 1

Most common female genital tract malignancy

Answer 1

carcinoma of the uterus

Question 2

Most common clinical presentation of carcinoma of the uterus

Answer 2

abnormal vaginal bleeding in peri/post menopausal women

Question 3

Risk factors for carcinoma of the uterus

Answer 3

Obesity, unopposed estrogen, tamoxifen(breast estrogen R antagonist), nulliparity, diabetes, late menopause, PCOS, lynch syndrome(heriditary nonpolyposis colorectal cancer) EXTRA ESTROGEN EXPOSURE

Question 4

Risk for carcinoma of the uterus decreased by:

Answer 4

ovulation, progestin therapy, combination BCPs, early menopause, multiparity LESS ESTROGEN EXPOSURE

Question 5

How evaluate abnormal vaginal bleeding

Answer 5

Pelvic exam/pap smear
Endometrial sampling
transvaginal ultrasound -good if endometrial stripe<5mm
Fractional D&C

Question 6

Endometrial hyperplasia treatment

Answer 6

intermittent/continuous progestin therapy w/ 3-6 month sample - depends on complexity and cytologic atypia

Question 7

How is an endometrial carcinoma staged

Answer 7

Surgically - requires fractional D&C

Question 8

Describe endometrial carcinoma stages

Answer 8

1 - confined to uterine corpus
a - endometrium, b < 1/2 myometrium c >1/2 myo
2 - invades endocervix/cervix
3 - in peritoneum, vagina, or lymph nodes
4 - distant metastases or inguinal lymph nodes

Question 9

Prognosis of endometrial carcinoma

Answer 9

affected by grade and histology
1,2,3 - 95, 85, 70 - 5 year survival
80% favorable

Question 10

What are the unfavorable endometrial carcinomas

Answer 10

papillary serous carcinoma, clear-cell carcinoma, squamous cell carcinoma, poorly differentiated carcinoma

Question 11

Where can endometrial carcinomas spread?

Answer 11

inguinal lymph - internal/external iliac-common iliac-paraaortic lymph, transtubal spread to abdomen

Question 12

Endometrial cancer treatment?

Answer 12

Depends on stage
1a/1b- TAH-BSO, peritoneal washings, remove large lymph nodes
1c/2 - TAH-BSO, cytology, and iliac/para-aortic node dissection +/- radiation
3/4 - surgical debulking+radiation+chemo

Question 13

second most common, but most lethal cancer of female genital tract

Answer 13

ovarian cancer - most deaths of any gyn malignancy

Question 14

Presenting symptoms of ovarian cancer

Answer 14

increasing girth, pelvic/abdominal fullness, vague pelvic discomfort - most present stage 3 or 4 age 50-70
dysuria, dyspareunia, constipation
PE - pelvic mass, ascites, abdominal mass

Question 15

Increased risk of ovarian cancer

Answer 15

(regular ovulation) white race, nulliparity, late childbearing, late menopause, family history, BRCA genetic mutation

Question 16

Decreased risk of ovarian cancer

Answer 16

(ovulation interrupted) oral contraceptives, multiparity, breast feeding, tubal ligation, hysterectomy

Question 17

Ovarian cancer screening

Answer 17

no effective screening techniques

Question 18

Ovarian cancer histology

Answer 18

80% epithelial (serous, mucinous, endometroid, clear cell)
10-15% germ cell (dysgerminomas, teratomas)
5% - gonadal-stromal (granulosa/theca cell, sertoli/leydig)
1% other (soft tissue, metastatic, Krukenberg)

Question 19

How does ovarian cancer spread?

Answer 19

Peritoneal spread - all over abdominal cavity

Nodal - inguinal-internal iliac-common iliac-paraaortic

Question 20

Ovarian cancer staging?

Answer 20

surgically
1 - confined to ovaries
2 - confined to pelvis
3 - confined to abdominal peritoneal surfaces/retroperitoneal lymph
4 - distant metastases

Question 21

Ovarian cancer surgery

Answer 21

surgical cytoreduction and sampling
- TAH-BSO, washings for cytology, omentectomy, diaphragm scraping, sample peritoneum, paraaortic dissection, EXCISE any visible tumor(bowel prep)

Question 22

Ovarian cancer post op

Answer 22

radiation and/or chemo
epithelial low grade - no further
high - platinum based chemo +/- paclitaxel
germ cell - plat chemo, bleomycin, etoposide
gonadal-stromal tumors - chemoresistant

Question 23

ovarian cancer prognosis

Answer 23

Epithelial 1,2,3 - 75-95, 65, 20 @ 5 years
Germ cell 1,2,3 - 95, 80, 60-70
Gonadal-stromal 1 - 90