Gyn malignancies Flashcards
What are the risk factors for type 1 endometrial adenocarcinoma?
estrogen exposure obesity extended reproductive life, nulliparous, late menopause hypertension exogenous estrogen younger peri-menopausal patients
Describe the normal progression of type 1 endometrial carcinoma
mutations in PTEN, KRAS–> microsatellite instability
atypical hyperplasia with increased gland: stroma ratio, cytologic changes
endometrioid carcinoma: confluent glands
What are the risk factors for type 2 endometrial adenocarcinoma?
unrelated to estrogen
more common in lean, older patients
associated with mutations in p53, Lynch syndrome
Describe the histology seen in type 2 endometrial carcinoma
serous histology
aggressive tumors with high N:C ratio, atypical mitoses
papillary architecture
What are indications for endometrial biopsy?
ALL cases of post-menopausal bleeding
endometrial cells on Pap in post- menopausla woman
abnormal bleeding in women with infertility/ anovulation
endometrial abnormality on ultrasound
Staging for endometrial cancers is _______
surgical/ pathological
List some pathologic features that suggest worse risk for recurrence of uterine cancer
- high histologic grade
- depth of myometrial invasion
- larger tumor size
- lymph/ vascular invasion
- aggressive histologic type (serous or clear cell)
What adjuvant therapies are used in advanced stage endometrial cancers?
pelvic radiation with vaginal cuff boost
Describe in relative terms the prognosis for endometrial cancer
relatively good- most patients present in stage I or II because disease has specific and noticeable symptoms
Recurrent endometrial cancer is generally considered incurable, with what key exception?
isolated vaginal cuff recurrence in a woman who has not received adjuvant radiation- can be treated with radiation +/- excision
Most ovarian tumors arise from the _________
surface epithelium
most common is serous carcinoma
List factors that increase risk of ovarian cancer
age
family history
infertility or uninterupted ovulation
personal cancer history
List factors that decrease the risk of ovarian cancer
OCP use
pregnancy
tubal ligation
breast feeding
List the general presenting symptoms of ovarian cancer
vague abdominal complaints, bloating, early satiety
What is the most common mode of ovarian cancer metastasis?
tumor exfoliation directly from the ovary to peritoneal surfaces
Differentiate the genetics that underly low grade vs high grade serous epithelial ovarian cancers
low grade: KRAS, BFAF, PTEN, B catenin
high grade: p53
______ is useful as a marker to track response to therapy for ovarian cancer, but is not useful as a cancer screening test
CA-125
How are most ovarian cancers treated?
surgery and adjuvant chemotherapy
Ovarian cancer is _______ staged
surgically
Unlike most other cancers, in ovarian cancer survival is improved by more complete __________
tumor debulking
the more tumor removed the better the survival
Women who do not achieve remission after initial therapy are considered_____ and have a very poor prognosis
“platinum refractory/resistant”
Describe in relative terms the prognosis for ovarian cancer
poor prognosis
most women present in laters stages due to vague symptoms, no effective screening
high rates of recurrence, in general recurrent disease is incurable
high grade serious is most common subtype
What factors explain the fact that cervical cancer is relatively rare in the US, but very common worldwide?
in the US we have a vaccine and good screening (Paps smears)
High risk HPV infection appears to be necessary for development of squamous cell carcinoma of the cervix, but not all women infected with high risk HPV develop cervical cancer. What other factors might play a role?
host immunity
smoking
co-infections
co-carcinogens
HPV infects the basal cells of the squamous epithelium at the _________ of the cervix
squamocolumnar junction
The hallmark histologic change seen in any HPV infected cells is ______
kiolocytosis- cells have dark irregular nuclei and perinuclear halo
List risk factors for cervical cancer
early first intercourse number of sexual partners smoking low SES high risk male partner other STIs
Detail the molecular progression of HPV infection into cervical carcinoma
HPV infects basal cell layer through microabrasions
DNA in episomal morphology at first during mild, moderate dysplasia
Eventually some virions integrate into host genome, disrupts E2 gene of virus so there is uncontrolled production of E6 and E7 (E2 normally inhibits E6 and E7).
E6 blocks p53, E7 blocks Rb
What are the presenting complaints for cervical cancer?
post-coital bleeding, foul smelling or bloody discharge, unilateral leg swelling, palpable pelvic mass
Cervical cancer is staged _____
clinically
Differentiate the treatment for stage 1 cervical cancer vs stage 2-4
stage 1: primary surgical management
stage 2+: whole pelvic radiation therapy, radiation sensitizing chemotherapy
- due to difficulty of getting good surgical margins with stage 2+ disease
Contrast central pelvic vs distant recurrence of cervical cancer
central pelvic recurrence: can use radiation only if NOT previously used during primary treatment; otherwise en bloc surgery that is massive but has reasonable cure rates
distant recurrence: poor cure rates, low mean survival.
