DSA pptx Clinical aspects of Carcinoma of uterus and ovaries (Tieman) - MT Flashcards
The leading cause of death in women in the United states each year is?
Heart disease
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?
- BRCA 1 on chromosome 17
- BRCA 2 on chromosome 13
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?
- nonpolypsis
- colorectal
- Mutation in mismatch repair genes
- Adenocarcinomas
The most common female genital tract malignancy in the US is?
Carcinoma of the uterus
Carcinomas of the uterus commonly present clinically as?
(sx and patient population)
- abnormal vaginal bleeds in perimenopausal or postmenopausal women
Risk factors for carcinomas of the uterus include? x9
- Obesity
- Diabetes
- Smoking
- Nulliparity
- unopposed estrogen stim (post menopausal)
- Tamoxifen
- late menopause
- Polycystic ovary syndrome
- Lynch syndrome
Things that decrease the risk of carcinomas of the uterus include? x5
- ovulation
- progestin therapy
- combo BCPs
- Early menopause
- Multiparity
Evaluation of abnormal vaginal bleeding could include what 4 tests / imaging techniques?
- pelvic exam / pap smear
- endometrial sampling
- Transvaginal US
- Fractional D&C
Staging of Endometrial carcinomas is ________ and requires ________.
- Surgically
- Fractional D&C
Staging of Endometrial carcinomas (1-4)
- 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
Unfavorable prognoses of endometrial carcinomas are given when what types of carcinomas are present? x4
- papillary serous carcinoma
- clear cell carcinoma
- Squamous cell carcinoma
- Poorly differentiated carcinoma
Tx of:
- stage 1a, 1b, grades I and II favorable histology
- Grade 3 or unfavorable histology, or stage 2 tumors
- stages 3 and 4 require
- TAH-BSO (total abdominal hysterectomy and bilateral salpingo oophorectomy), peritoneal washings and removal of any enlarged LNs
- TAH-BSO, cytology, iliac/para-aortic node dissection, w/ or w/o radiation
- surgical debulking, radiation, chemotherapy
what is the most lethal cancer of the female genital tract?
Why is it so lethal?
- Ovarian cancer
- lethality due to late stage of diseae at diagnosis and method of spread
Presenting Sx of ovarian cancer are usually vague and can include? x3
- increasing girth
- pelvic/abdominal fullness
- vague pelvic discomfort
Most patients are diagnosed at what stages and in what age group for ovarian cancer?
- stages 3/4
- age group 50-70
increased risk of ovarian cancer comes from what 6 factors?
- White
- nulliparity/infertility
- late childbearing
- late menopause
- family hx
- BRCA genetic mutation
(regular ovulation)
Decreased risk of ovarian cancer comes from? x5
- oral contraceptives
- multiparity
- breast feeding
- tubal ligation
- hysterectomy
(things that interrupt ovulation)
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?
Serous epithelial tumor (80% of all ovarian cancers are epithelial, 55% of epithelial tumors are serous)
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?
- Teratoma, embryonal cell carcinoma
- usually under age of 30
5% of all ovarian cancers are gonadal stromal tumors. What is an example type and what age is the dx usually made in?
- granulosa cell-theca cell tumors secreting E/P
or
Sertoli leydig cell tumors secreting androgens
- usually over age of 50
Ovarian cancers are staged Surgically as stages 1-4. What defines each stage?
- 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
What is the most important aspect for long term prognosis of ovarian cancer?
Excision of any visible tumor
Tx of ovarian cancers that are:
- Epithelial tumors: stage 1 low grade, stage 1 high grade?
- Germ cell tumors?
- Gonadal stromal tumors
- stage 1 low grad = no further tx
stage 1 high grade = platinum based chemo
- Germ cell = platinum based chemo, bleomycin, etoposide
- Gonadal stromal = relatively chemoresistant
