DSA pptx Clinical aspects of Carcinoma of uterus and ovaries (Tieman) - MT

Question 1

The leading cause of death in women in the United states each year is?

Answer 1

Heart disease

Question 2

10% of breast and ovarian cancers are hereditary.

What are the 2 genes and their respective chromosomes that play a role in the hereditary versions of the cancer?

Answer 2

1. BRCA 1 on chromosome 17
2. BRCA 2 on chromosome 13

Question 3

Lynch II syndrome (HNPCC) is a ___1___ ___2____ cancer syndrome.

• Mutations occur in what general type of genes?
• In this syndrome, the colon, endometrium, breast, ovary, and pancreas are affected by what?

Answer 3

1. nonpolypsis
2. colorectal
   - Mutation in mismatch repair genes
   - Adenocarcinomas

Question 4

The most common female genital tract malignancy in the US is?

Answer 4

Carcinoma of the uterus

Question 5

Carcinomas of the uterus commonly present clinically as?

(sx and patient population)

Answer 5

• abnormal vaginal bleeds in perimenopausal or postmenopausal women

Question 6

Risk factors for carcinomas of the uterus include? x9

Answer 6

• Obesity
• Diabetes
• Smoking
• Nulliparity
• unopposed estrogen stim (post menopausal)
• Tamoxifen
• late menopause
• Polycystic ovary syndrome
• Lynch syndrome

Question 7

Things that decrease the risk of carcinomas of the uterus include? x5

Answer 7

• ovulation
• progestin therapy
• combo BCPs
• Early menopause
• Multiparity

Question 8

Evaluation of abnormal vaginal bleeding could include what 4 tests / imaging techniques?

Answer 8

1. pelvic exam / pap smear
2. endometrial sampling
3. Transvaginal US
4. Fractional D&C

Question 9

Staging of Endometrial carcinomas is ________ and requires ________.

Answer 9

1. Surgically
2. Fractional D&C

Question 10

Staging of Endometrial carcinomas (1-4)

Answer 10

• stage 1 = confined to uterine corpus

1a = confined to endometrium or <50% myometrial invation

1b = invasino to > 1/2 of myometrium

• stage 2 = invades cervix stroma
• stage 3 = tuor invades serosa or adnexa, vagina, or LNs
• stage 4 = peritoneum, distant metastases, invasion of bladder or bowel mucosa, or inguinal LN involvement

Question 11

Unfavorable prognoses of endometrial carcinomas are given when what types of carcinomas are present? x4

Answer 11

• papillary serous carcinoma
• clear cell carcinoma
• Squamous cell carcinoma
• Poorly differentiated carcinoma

Question 12

Tx of:

1. stage 1a, 1b, grades I and II favorable histology
2. Grade 3 or unfavorable histology, or stage 2 tumors
3. stages 3 and 4 require

Answer 12

1. TAH-BSO (total abdominal hysterectomy and bilateral salpingo oophorectomy), peritoneal washings and removal of any enlarged LNs
2. TAH-BSO, cytology, iliac/para-aortic node dissection, w/ or w/o radiation
3. surgical debulking, radiation, chemotherapy

Question 13

what is the most lethal cancer of the female genital tract?

Why is it so lethal?

Answer 13

• Ovarian cancer
• lethality due to late stage of diseae at diagnosis and method of spread

Question 14

Presenting Sx of ovarian cancer are usually vague and can include? x3

Answer 14

• increasing girth
• pelvic/abdominal fullness
• vague pelvic discomfort

Question 15

Most patients are diagnosed at what stages and in what age group for ovarian cancer?

Answer 15

1. stages 3/4
2. age group 50-70

Question 16

increased risk of ovarian cancer comes from what 6 factors?

Answer 16

• White
• nulliparity/infertility
• late childbearing
• late menopause
• family hx
• BRCA genetic mutation

(regular ovulation)

Question 17

Decreased risk of ovarian cancer comes from? x5

Answer 17

• oral contraceptives
• multiparity
• breast feeding
• tubal ligation
• hysterectomy

(things that interrupt ovulation)

Question 18

Patient presents with hx of vague non specific abdominal discomfort, dyuria, and constipation. On physical exam, ascites and an abdominal mass is identified.

Your differential includes ovarian cancer, which is most likely what type?

Answer 18

Serous epithelial tumor (80% of all ovarian cancers are epithelial, 55% of epithelial tumors are serous)

Question 19

Germ cell type ovarian cancers are usually 10-15% of all ovarian cancers. What is an example of one and what age is the dx usually made in?

Answer 19

1. Teratoma, embryonal cell carcinoma
2. usually under age of 30

Question 20

5% of all ovarian cancers are gonadal stromal tumors. What is an example type and what age is the dx usually made in?

Answer 20

1. granulosa cell-theca cell tumors secreting E/P

or

Sertoli leydig cell tumors secreting androgens

2. usually over age of 50

Question 21

Ovarian cancers are staged Surgically as stages 1-4. What defines each stage?

Answer 21

• Stage 1 = tumor confined to ovaries
• Stage 2 = tumor spread confined to pelvis
• Stage 3 = tumor spread to abdominal peritoneal surfaces including omentum, surface liver/ spleen. Mets to retroperitoneal LNs
• Stage 4 = distant metastases. IVA: pleural effuion. IVB hepatic/splenic parenchymal mets, extra abd LNs

Question 22

What is the most important aspect for long term prognosis of ovarian cancer?

Answer 22

Excision of any visible tumor

Question 23

Tx of ovarian cancers that are:

1. Epithelial tumors: stage 1 low grade, stage 1 high grade?
2. Germ cell tumors?
3. Gonadal stromal tumors

Answer 23

1. stage 1 low grad = no further tx

stage 1 high grade = platinum based chemo

2. Germ cell = platinum based chemo, bleomycin, etoposide
3. Gonadal stromal = relatively chemoresistant