GYN malignancy Flashcards
1
Q
what is endo CA
A
most common
- epithelial tumor
2
Q
2 types of edno CA
A
type 1 - E dependent
type 2 E indep
3
Q
risk factors for E dep
A
- obesty
- chronic anov (PCOS)
- unopposed E use
- tmoxifen
- early menarche/late meno
- Fam hx
4
Q
prevention
A
avopid risk factors
5
Q
screening for endo**
A
none
6
Q
3 warning signs for endo
A
- post-meno bleeds
- irreg vag. bleeds
- abdo bloating, pain, bowel sx
7
Q
diagnostic test for endo ca
A
- endo biopsy with pipelle instrument
- US is not appropriate replacement
8
Q
morphology of type 1
A
- resembles normal endo
- increased gland to stroma
- cribiform architecture
- nuclear atypia
9
Q
what is grading in endo
A
amount of solid area
- more solid area is worse
10
Q
what can be seen in E dependent before
A
precursor lesions
11
Q
4 types of lesions
A
simple vs. complex
with or without atypia
complex with atypia has 50% risk
12
Q
2 types of type 2
A
serous (papillary)
clear cell
- both are high grade
13
Q
morpho of serous
A
- papillary archi
- high grade nuclear
- macro nuleai
14
Q
morpho of clear cell
A
- clear cytoplasm
- high nuclear grade
- various architecture
15
Q
precursors for serous and clear cell
A
serous - endometrial intraepitheliam carcinoma
clear cell - none
16
Q
4 prognostic factors
A
- myoinvasion
- lymphovascular invasion
- cervical invasion
- mets
17
Q
mgmt of edno CA
A
surgical
18
Q
outcomes for 2 types
A
type 1 - usually found early and cured
type 2 - usually found late and poor
19
Q
etiology of cerv. CA
A
HPV- most only dev. sublincal infection
20
Q
3 cofactors
A
- smoking
- immunocompromise
- OCP
21
Q
2 types of cerv. prevention
A
1ry - avoid HPV and cofactors
2ry - paps
22
Q
2 types of 2ry prevention
A
- traditional - pap smear
- liquid based cytology medium
- less false neg
- increase sens
23
Q
tips for collection
A
- before bimanual
- don’t contam. with lube
- collect before STD swabs
- ensure visualization
24
Q
what are challenges in cerv. screening
A
- high false neg
- less reduction in adenocarcinoma
- is opportunitic - relies on pt and halthcare provider
25
when to start screen
21 - long time to dev SIL and LSIL is transient
26
how often
annual is standard practice, but if have negs, can do every 2-3 years because of sig. lead time
27
when to stop
consider stopping at 65-70 or hysterectomy with normal pap Hx
- continue if at risk
- continure in hyterectomy if HSIL in past
28
what to do with abnormal result
colposcopic eval
29
*** bethesda classification
satisfactory vs. unsat
| neg vs. epithelial cell abnormal
30
2 types of abnormal
1. squamous
- ASC (us or H)
- LSIL
- HSIL
- carcinoma
2. glandular
- AGC atypical glandular cells
- AGC favour neoplasia
- adenocarcinoma
31
what is only one that doesn't need colposcopy
ASC-US
| - up to 5%
32
option for ASC-US
1. immed. colposcopy
2. repeat smears q6mox3
3. HPV DNA test
33
5 alternative causes for abnormal smears
1. atrophic changes
2. inflamm/infection
3. regen after injury
4. CA of other source
5. previous radiation
34
what is pap test NOT
screening test, not a diagnostic test
35
4 types of squamous lesions
normal squam cell
LSIL
HSIL
SCC
36
** what is cytopathology
koilocyte - HPV infected cell
- enlarged nuc
- irreg nuc
- hyperchromasia
- binucleation
- cytopasmic halo
37
3 types of glandular leasion
normal endo glands
adenocarcinoma in situ
adenocarcinoma
38
what is done in colposcopy
look inside and biopsy if abnormal
39
2 options for lesions
1. exision
- cone biopsy - general
- LEEP - in office
2. ablation - no patho
- laser
- cautery
- cryotherapy
40
5 warning signs of cerv CA
1. abnormal pap
2. abnormal bleeds - ESP post coital
3. pelvic pain/discharge
4. bowel or bladder
5. flank pain/sciatica/lower limb edema (terrible triad)
41
** prototypical case
42 yo female
heathy smoker
no pap for a few years
new onset coital bleeds
42
what is role for imaging
none- do a physcial
43
clinical mgmt plan
1. refer to gyn onc
2. determine stage
3. determine optimal ther
44
** what is special about staging of cervical
only one done clincally - with hands
45
what is mgmt
tailored to pt
- advanced - chemorad
- early - surg or chemo rad
46
2 most common histo types
SCC
| endocervical adenocarcinoma
47
morpho of SCC
sheets of malignant cells
| - sometimes keratinzation
48
morpo of adenocarcinoma
presence of atypical glands growing in disorganized fashion and invading cervial stroma
49
outcomes
early - cured with surg or chemorad
| late- maybe cured with chemorad
50
SE of therapy
- loss of fert
- meno
- sexual dys
- bowel bladder tox
51
3 parts of ovary and their potential neoplasms
1. primordial germ cells - germ cell tumors
2. sex cords - stromal tumors
3. epitheliom - carcinoma
52
epi of of germ cell tumors
the good
- 10-15%
- young females
- typically curable even with mets
53
types of germ cell tumors and their effect
```
1. mature teratoma (95%) - benign
all the rest are malig
2. immature teratoima
3. dysgerminoma
4. yolk sac carc
5. embryonal carc.
6. choriocarc
7. gonadoblastoma
```
54
histo of teratoma
derivatives of any cell layer
| - made up of mature adult type tissue
55
epi of stromal tumors
the bad (3-5%)
- women of all ages
- usually early stage and cured
56
epi of epithelial tumors
the ugly (80-85%)
- 5 subtypes
- each has it's own chars
57
5 subtypes
1. serous - most common
2. endometriod
3. mucinous
4. clear cell
5. transitionnal
58
histo of serous
often bilateral ovaries
| - solid and cyctic mass with papillary projections
59
histopath of serous
- pap archi
- high nuclear grade
- macronuleaoli
- abundant mitosis
- psammoma bodies
60
histopath of mucious
- mucin producing
- large, unilateral
- atypia varies
- pools of mucin
61
endometrioid histopath
unilat
- often hemmoragic
- morpho ident to endo CA
62
histpath of clear cell
unilat
- solid and cystic mass
- may be hemorragic
63
2 risk factors for epithelial ovarian Ca
1. incessant oviualtion
- nulliparity
- early menarche/ late meno
- not on OCP
2. genetics
64
3 related familial sysndromes
1. site specific familial ovarian cancer syndrome
2. BRCA
3. lynch
10% have gentic link
65
prevention/screening
1. avoidance of risk factors - OCP, childbearing
2. prophylactic surg in high risk women
3. no good screening - US is NOT good
66
screening for women at high risk (BRCA)
1. transvag US q6 months
2. mammography
3. colonoscoly
4. prophylactic surg
67
warning signs
often asymptomatic
1. abdo bloating
2. abdo pelvic pain
3. bowel/bladder
4. vag bleeds
68
prototypical case
```
60yo female
- meno 8 years
- 6 month sx
On exam
- fluid wave
- omental cake
- fixed irreg mass
- cul-de-sac nodularity
```
69
4 diagnositc tests
1. pelvic transvag US
2. tumor markers
3. CT
4. CXR, barium enema
70
what is only type with no tumor markers
immature teratoma
71
tumor marker for epi, germ cell, stroma
epi - CA-125
germ - LDH, AFP, B-hCG
stromal - inhibin
72
limitations of CA-125
premeno - low spec., affected by benigh conditions
post-meno
- very hiogh PPV
- non-mucinous
73
*** what is involved in calculating risk of malig. index for adnexal masses
RMI = UxMxCA125
74
what is U
U = 1 (U/S 0 or 1)
U = 4 (U/S 2-5)
1 point for presence of: multilocarity, bilateral, solid, ascites, mets
75
what is M
```
M = 4 for postmeno
M = 1 for premeno
```
76
CA-125
absolute value
77
where is cutoff
RMI>200 - refer
78
main treatment
surg - unless too unwell
79
4 roles for surg
1. diagnosis
2. staging
3. debulking
4. adjuvant facilitation
80
what is role of debulking
relat. between amount of disease left and length of survival
81
3 prognostic factors
1. stage
2. optimal debulking
3. tumor biol
82
what is vulvar CA
skin CA of the vulva
83
epi of vulvar
- uncommon
- 90% SCC
- can often be a second primary malig (cervix/anus)
84
2 types of vulvar
1. type 1 - HPV related
| 2. type 2 - non HPV
85
risks for type 1 (3)
HPV
smoking
immune suppress
86
risk for type 2
chronic vulvar disease
| - lichen sclerosis
87
prevention/screening
- avoid risk factors
- no good screen
- treat preinvasive lesions
- surveillance colposcopy
88
warning sx
- vulvar itch
- burning
- irreg. bleeding
- vulvar lesion
- groin pain swelling
- bowel/bladder pain in advanced
89
diagnostic tests
- physical exam
- colposcopy if nothing visible on physical
- skin biopsy
90
keys to surgical mgmt
- wide local margin
- assess sentinal nodes
- neoadjuvant chemorad for locally advanced disease
91
histopath
- most are SCC
| - look at depth, tumor width, lymph invasion, status of margins
92
reasons behind sentinal LN
- mets to groin nodes
- risk increases exponentially when depth >1mm
- node dissection is morbin
- do sentinal node instead and if clear leave the rest
93
what does sentinal LN allow
ultrastaging of this node and detection of small mets
94
outcomes for vulvar
depends on the stage
