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NM By Myself > Gyn Cancer NM > Flashcards

Gyn Cancer NM Flashcards

1
Q

Corpus uteri N

A

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

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2
Q

Corpus uteri M

A

Lung - - hormonal therapy
Liver
Bone
Skin

Inguinal LN (above renal pelvis)
Peritoneal implants
Malignant ascites

Stage IVB

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3
Q

Corpus uteri cancer
Risk

A

Hyperestrogenism - - nullipara, anovulation, premature menarche, late menopause, polycystic ovaries, tamoxifen therapy, HRT
Obesity
Comorbidities - - arterial hypertension, DM, Lynch

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4
Q

Corpus uteri cancer
Endometrioid type 80%

A

Estrogen - dependent
Type 1
Earlier - - Better prognosis
Precede - endometrial hyperplasia
Ass with chronic estrogen exposure
Mutations of PTEN, PIK3CA, K-Ras, beta-catenin genes

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5
Q

Corpus uteri cancer
Non Endometrioid

A

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

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6
Q

Corpus uteri treatment

A

TAH + BSO
High risk - - grade 3, >50% myometrial invasion, papillary serous, carcinosarcoma and clear cell carcinoma - - radical pelvic and paraaortic lymphadenectomy

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7
Q

Corpus uteri sarcoma

A

Leiomyosarcoma - - rare LN
Endometrial stromal sarcoma
Adenosarcoma

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8
Q

Leiomyosarcoma

A

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

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9
Q

Endometrial stromal sarcoma

A

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

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10
Q

Adenosarcoma

A

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

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11
Q

Corpus uteri sarcoma
Risk

A

Risk - - tamoxifen therapy or long term COCs, previous pelvic radiation
Aggressive - - intense FDG uptake

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12
Q
A

Endometrial cancer

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13
Q

Uterus PET indication

A

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

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14
Q

PET false

A

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

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15
Q

Uterus benign PET

A

Uterine fibroid
Adenomyosis
Endometriosis
Cyclic activity of uterus or ovary in premenopausal women

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16
Q

Oral metformin PET

A

Diffuse uptake in bowel
Stop 48h

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17
Q

PET after treatment
Cancer of uterus

A

After surgery or chemo - - 2 weeks
After radio - - 6-12 weeks

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18
Q

Cervical cancer FIGO

A

Ia2 - stromal invasion 3-5 mm
Ib1 - stromal invasion >5 mm
Ib2 - visible lesion 2-4 cm
IIa1 - visible lesion <4 cm

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19
Q

Cervical cancer N

A

Drain to parametria, external iliac, obturator LN (most common SLNB)
1/3 of locally advanced - - paraaortic LN MTS

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20
Q

Cervical cancer M

A

Liver
Lung
Bone (spine)
Adrenal

Mediastinal LN
Supraclavicular LN

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21
Q

Cervical cancer origin

A

Squamocolumnar junction (ectocervix intra vagina) - - moves to endocervix with age - - cancer arise in transformation zone between old and new SCJ

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22
Q

Cervical cancer type

A

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

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23
Q

Cervical cancer risk

A

90% HPV16, 18
Early sex
Multiple partners
STD
Multiparity
Smoking
Long use of COC

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24
Q

Postcoital bleeding

A

Anemia

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25
Q

Peritoneal seeding

A

Sister Mary Joseph’s LN (umbilical)

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26
Q

Cervical cancer
Paraneoplastic sy

A

Cushing
SIADH
Carcinoid
Hypoglycemia

27
Q

Cervical cancer
Paraaortic LN

A

Predictor of recurrence
Important for treatment strategy
Surgical staging

28
Q

Cervical cancer
PET MRI

A

Useful for IB2, soft tissue and Parametrial involvement

29
Q

Hysterectomy

A

Only if N0

30
Q

Conization

A

Depth of tumor invasion <3 mm
N0

31
Q

Wertheim - Meigs operation

A

TAH
Upper 1/3 of vagina
Parametrial and uterosacral ligament
Pelvic and paraaortic LN

32
Q

Cervical cancer
CT

A

92% accurate for stage IIIB-IVB
Not for Parametrial invasion

33
Q

Cervical cancer
MRI

A

Ideal for local staging
Accurate in selecting operative candidates
Superior soft tissue contrast

34
Q

Cervical cancer
FDG PET

A

100% sensitivity and 99% specificity for LN >5 mm and for MTS
>MRI and CT in adenopathy
Higher SUV on primary lesion or metastatic pelvic/paraaortic LN - - increase risk of adverse events and death
NCCN - - IB2 or higher
ACR - - IB1 or higher
When paraaortic LN found at surgery
Incidental invasive cervical cancer at hysterectomy
To define targets for radiotherapy planning
Suboptimal for early stage
3 - 6months after chemo radio
Not for routine unless proven recurrence

35
Q
A

Cervical cancer

36
Q
A

Cervical cancer

37
Q
A

Cervical cancer

38
Q

Ovarian cancer M

A

Liver:
Perihepatic - - smooth, elliptic - - stage III - - resectable
Parenchymal - - less defines, surrounded by parenchyma - - stage IV, non resectable
Lung
Pleural effusion
Adrenal
Spleen
Bone
Intestine - - morbidity

39
Q

Ovarian cancer epithelial 90%

A

High grade serous 70% - - precursor - - serous tubal intraepithelial carcinoma, TP53 and BRCA
Low grade serous 5% - - precursor - - ovarian surface epithelial inclusion cysts, KRAS and BRAF
Clear cell
Endometrioid - - endometrial hyperplasia
Mucinous - - variable density

40
Q

Ovarian cancer non epithelial 10%

A

Germ cell

41
Q

Calcification in cysts

A

Serous

42
Q

Suspicious malignancy ovary

A

Solid mass with necrosis
Non fat nodular components in cystic lesion
Irregular thick wall or septa >3 mm
Vascularity
Enhancement
Ascites, peritoneal MTS, lymphadenopathy

43
Q

CA 125 > 30 U/mL

A

Premenopausal Endometriosis
Cystadenoma
Pelvic inflammatory disease
Peritoneal dissemination of non ovarian cancer

44
Q

Malignant ascites

A

Peritoneal MTS
Omentum

45
Q

Primary peritoneal carcinona

A

Poor prognosis
Biopsy to confirm
Partially solid/cystic mass separate from ovary associated with hydrosalpinx
No hydrosalpinx - - sausage shaped solid adnexal mass
At least stage II

46
Q

Latzko classic triad
Primary peritoneal cancer

A

Intermittent profuse serosanguinous Vaginal discharge
Colicky pain relieved by discharge
Adnexal mass

47
Q
A

Ovarian cancer

48
Q
A

Mature cystic teratoma

49
Q
A

Ovarian cancer

50
Q

Ovarian cancer MRI

A

Problem solving
When CT is contraindicated
Better in DD benign vs malignant
Local extension
Local recurrence

51
Q

Ovarian cancer PET CT

A

Tumor characterisation, local extent, nodal involvement, MTS
>US, CT, MRI in staging of epithelial cancer, regional LN, peritoneum esp in right upper abdomen and small bowel mesentery, residual
SUV at staging predict survival
Locally advanced epithelial cancer treated with neoadjuvant therapy - - responders vs non responders
Corpus luteum cyst - - high uptake in premenopausal
Not optimal for lesions <5 mm

52
Q

Vaginal cancer

A

30-50% had prior hysterectomy
90% SCC - - HPV, post menopause
10% adenocarcinoma - - exposure to DES, congenital T-shaped uterus, young
FDG useful in recurrence

53
Q

Vulvar Stage

A

Ib - T1b - lesion <2 cm
II - T2 - any size, adjusent perineal structures

54
Q

Vulvar cancer
LN

A

Inguino-femoral
Labia - - superficial inguinal
Midline - - deep inguinal bilateral

55
Q

Vulvar cancer risk

A

Smoke
Lichen sclerosis
Intraepithelial neoplasia
HPV 60%

56
Q

Vulvar cancer
Unilateral dissection

A

Unifocal tumor <2 cm
Lateral lesion >1 cm from midline
No palpable adenopathy

57
Q

Vulvar cancer
Bilateral dissection

A

Tumor >2 cm
Central lesion
Nodal MTS
Complications - - better SLNB

58
Q
A

Vaginal cancer

59
Q

Vulvar cancer PET CT

A

Staging
Recurrence
Treatment planning
SLNB still required

60
Q

PET MRI

A

Management of patients with cervical and ovarian cancer
Less useful in endometrial carcinoma

61
Q

PET MRI > PET CT

A

Superior for detecting small metastatic LN and for distinguishing LN from anatomic structures

62
Q
A

2 on the right
1 on the left

63
Q
A

External iliac bilaterally

NM By Myself (25 decks)

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