Gyn malignancies

Question 1

What are the risk factors for type 1 endometrial adenocarcinoma?

Answer 1

estrogen exposure
obesity
extended reproductive life, nulliparous, late menopause
hypertension
exogenous estrogen 
younger peri-menopausal patients

Question 2

Describe the normal progression of type 1 endometrial carcinoma

Answer 2

mutations in PTEN, KRAS–> microsatellite instability
atypical hyperplasia with increased gland: stroma ratio, cytologic changes
endometrioid carcinoma: confluent glands

Question 3

What are the risk factors for type 2 endometrial adenocarcinoma?

Answer 3

unrelated to estrogen
more common in lean, older patients
associated with mutations in p53, Lynch syndrome

Question 4

Describe the histology seen in type 2 endometrial carcinoma

Answer 4

serous histology
aggressive tumors with high N:C ratio, atypical mitoses
papillary architecture

Question 5

What are indications for endometrial biopsy?

Answer 5

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

Question 6

Staging for endometrial cancers is _______

Answer 6

surgical/ pathological

Question 7

List some pathologic features that suggest worse risk for recurrence of uterine cancer

Answer 7

• high histologic grade
• depth of myometrial invasion
• larger tumor size
• lymph/ vascular invasion
• aggressive histologic type (serous or clear cell)

Question 8

What adjuvant therapies are used in advanced stage endometrial cancers?

Answer 8

pelvic radiation with vaginal cuff boost

Question 9

Describe in relative terms the prognosis for endometrial cancer

Answer 9

relatively good- most patients present in stage I or II because disease has specific and noticeable symptoms

Question 10

Recurrent endometrial cancer is generally considered incurable, with what key exception?

Answer 10

isolated vaginal cuff recurrence in a woman who has not received adjuvant radiation- can be treated with radiation +/- excision

Question 11

Most ovarian tumors arise from the _________

Answer 11

surface epithelium

most common is serous carcinoma

Question 12

List factors that increase risk of ovarian cancer

Answer 12

age
family history
infertility or uninterupted ovulation
personal cancer history

Question 13

List factors that decrease the risk of ovarian cancer

Answer 13

OCP use
pregnancy
tubal ligation
breast feeding

Question 14

List the general presenting symptoms of ovarian cancer

Answer 14

vague abdominal complaints, bloating, early satiety

Question 15

What is the most common mode of ovarian cancer metastasis?

Answer 15

tumor exfoliation directly from the ovary to peritoneal surfaces

Question 16

Differentiate the genetics that underly low grade vs high grade serous epithelial ovarian cancers

Answer 16

low grade: KRAS, BFAF, PTEN, B catenin

high grade: p53

Question 17

______ is useful as a marker to track response to therapy for ovarian cancer, but is not useful as a cancer screening test

Answer 17

CA-125

Question 18

How are most ovarian cancers treated?

Answer 18

surgery and adjuvant chemotherapy

Question 19

Ovarian cancer is _______ staged

Answer 19

surgically

Question 20

Unlike most other cancers, in ovarian cancer survival is improved by more complete __________

Answer 20

tumor debulking

the more tumor removed the better the survival

Question 21

Women who do not achieve remission after initial therapy are considered_____ and have a very poor prognosis

Answer 21

“platinum refractory/resistant”

Question 22

Describe in relative terms the prognosis for ovarian cancer

Answer 22

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

Question 23

What factors explain the fact that cervical cancer is relatively rare in the US, but very common worldwide?

Answer 23

in the US we have a vaccine and good screening (Paps smears)

Question 24

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?

Answer 24

host immunity
smoking
co-infections
co-carcinogens

Question 25

HPV infects the basal cells of the squamous epithelium at the _________ of the cervix

Answer 25

squamocolumnar junction

Question 26

The hallmark histologic change seen in any HPV infected cells is ______

Answer 26

kiolocytosis- cells have dark irregular nuclei and perinuclear halo

Question 27

List risk factors for cervical cancer

Answer 27

early first intercourse
number of sexual partners
smoking
low SES
high risk male partner
other STIs

Question 28

Detail the molecular progression of HPV infection into cervical carcinoma

Answer 28

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

Question 29

What are the presenting complaints for cervical cancer?

Answer 29

post-coital bleeding, foul smelling or bloody discharge, unilateral leg swelling, palpable pelvic mass

Question 30

Cervical cancer is staged _____

Answer 30

clinically

Question 31

Differentiate the treatment for stage 1 cervical cancer vs stage 2-4

Answer 31

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

Question 32

Contrast central pelvic vs distant recurrence of cervical cancer

Answer 32

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.