Gyn Cancer NM Flashcards
Corpus uteri N
10% in stage I
Pelvic or paraaortic - - 50% reduced 5-year survival
2/3 lower drain like cervix
1/3 upper drain directly to paraaortic
Corpus uteri M
Lung - - hormonal therapy
Liver
Bone
Skin
Inguinal LN (above renal pelvis)
Peritoneal implants
Malignant ascites
Stage IVB
Corpus uteri cancer
Risk
Hyperestrogenism - - nullipara, anovulation, premature menarche, late menopause, polycystic ovaries, tamoxifen therapy, HRT
Obesity
Comorbidities - - arterial hypertension, DM, Lynch
Corpus uteri cancer
Endometrioid type 80%
Estrogen - dependent
Type 1
Earlier - - Better prognosis
Precede - endometrial hyperplasia
Ass with chronic estrogen exposure
Mutations of PTEN, PIK3CA, K-Ras, beta-catenin genes
Corpus uteri cancer
Non Endometrioid
Estrogen independent
Type 2
Papillary and clear cell
Aggressive, extrauterine
serous (prototype of type 2)
clear cell carcinoma (features of type 1 and 2)
No ass with estrogen exposure, no premalignant disease
Corpus uteri treatment
TAH + BSO
High risk - - grade 3, >50% myometrial invasion, papillary serous, carcinosarcoma and clear cell carcinoma - - radical pelvic and paraaortic lymphadenectomy
Corpus uteri sarcoma
Leiomyosarcoma - - rare LN
Endometrial stromal sarcoma
Adenosarcoma
Leiomyosarcoma
15-40% smooth muscle tumor
>40 y
Large, 6-10 cm
>5 cm - - poor prognosis
Recurrence in lungs 40%
FDG avid in primary tumor and MTS
CT - enlarged uterus with areas of necrosis
Endometrial stromal sarcoma
10-25% mesenchymal tumor
>35-55 y
Large mass with myometrial component
Spreads along fallopian tubes, uterine ligaments, pelvic veins
Often sensitive to hormones
High rate of recurrence
CT - - enhancing mass, loss of pelvic fat planes
Adenosarcoma
6% benign epithelium and malignant stroma
Polypoid mass with septa, lattice like appearance, expands endometrial cavity
Large, up to 9 cm
May protrude through dilated cervical canal
Recurrence in vagina and pelvis
CT - large solid mass, regions of necrosis, small cystic areas
Corpus uteri sarcoma
Risk
Risk - - tamoxifen therapy or long term COCs, previous pelvic radiation
Aggressive - - intense FDG uptake
Endometrial cancer
Uterus PET indication
Evaluation of extrauterine disease
Patient selection and surgical planning
Response to therapy, recurrence
Early stage only if high risk
Not for primary staging, early carcinomatosis, microMTS, low grade, serous or mucinous
PET MRI - - infiltration in surrounding tissue
PET false
False negative:
Lesion <1 cm
Grade I endometrial cancer
Well-diff mucinous ovarian cyst adenocarcinoma
Small pelvic tumor adjacent to bladder or ureter
Peritoneal carcinomatosis
Uterus benign PET
Uterine fibroid
Adenomyosis
Endometriosis
Cyclic activity of uterus or ovary in premenopausal women
Oral metformin PET
Diffuse uptake in bowel
Stop 48h
PET after treatment
Cancer of uterus
After surgery or chemo - - 2 weeks
After radio - - 6-12 weeks
Cervical cancer FIGO
Ia2 - stromal invasion 3-5 mm
Ib1 - stromal invasion >5 mm
Ib2 - visible lesion 2-4 cm
IIa1 - visible lesion <4 cm
Cervical cancer N
Drain to parametria, external iliac, obturator LN (most common SLNB)
1/3 of locally advanced - - paraaortic LN MTS
Cervical cancer M
Liver
Lung
Bone (spine)
Adrenal
Mediastinal LN
Supraclavicular LN
Cervical cancer origin
Squamocolumnar junction (ectocervix intra vagina) - - moves to endocervix with age - - cancer arise in transformation zone between old and new SCJ
Cervical cancer type
SCC 70% - - cavitary lung MTS - - highest FDG SUV
Adenocarcinoma - - 25%, aggressive
Small cell - - 2%, PAP smear not sensitive, aggressive
Clear cell adenocarcinoma - - exposure to diethylstilbestrol in utero
Adenoma malignum - - from columnar epithelium of endocervical canal, history of copious watery discharge, poor prognosis, ass with Peutz-Jeghers
Cervical cancer risk
90% HPV16, 18
Early sex
Multiple partners
STD
Multiparity
Smoking
Long use of COC
Postcoital bleeding
Anemia
Peritoneal seeding
Sister Mary Joseph’s LN (umbilical)