Gyn Onc Flashcards
Types of ovarian cancer
Epithelial (59%) Serous cystadenoma- bilat, psammoma bodies Mucinous Undifferentiated Endometrioid Clear cell Brenners Squamous
Tumor markers
CEA-elevated in mucinous tumors HE4- epithelial ovarian ca AFP- endodermal sinus/yolk sac tumor HCG- choriocarcinoma LDH- dusgerminoma Inhibin- granules a cell tumor Sertoli Leydig- testosterone
Types of germ cell tumors
Immature teratomas
Dysgerminoma can be associated with Gonadoblastoma
Endodermal sinus (Schiller Duvall bodies)
Mature teratoma /(malignant potential 1% SCC)
Choriocarcinoma
Sex cord stromal tumors
Granulosa cell tumors- call exner bodies, coffee bean nuclei.
Often associated with endometrial hyperplasia
Inhibin
Sertoli-stromal cell tumors- virilizing, Reinke crystals
Adjuvant breast cancer therapies
Use in?
Menopausal status?
Risks
tamoxifen
Raloxifene
AI
ER+/unknown
Both
VTE
ER+
Post
VTE
ER+/unknown
Post
Bone loss
Stage 1 cervical cancer
1A: <5 mm
1B: Greater than or equal to 5 mm
Stage 2 cervical cancer
Beyond uterus, upper 2/3 of vagina but not to pelvic sidewall
2A1: clinical lesions<4cm in greatest dimension
2A2: > or = 4cm
2B: extension to parametrium
Stage 3 cervical ca
3A: lower 1/3 vagina, not pelvic sidewalk
3B: to pelvic SW, hydronephrosis
3C1: pelvic LNs
3C2: paraaortic Lns
Cervical cancer stage 4
4A: spread to adjacent pelvic organs
4B: spread to distant organs
*cervical cancer staging is clinical**
Treatment for cervical cancer
1A1: cone or simple hysterectomy
1A2: rad hyst + nodes
1B-2A: surgery, nodes OR radiation + cis platinum
2B and up: radiation and cis platinum
High risk/oncogenic HPV subtypes
16,18,31,33,35,45,52,58
Ovarian cancer staging
Stage 1
Confined to ovary, tube
1A limited to 1 ovary/tube, capsule intact
1B limited to both ovaries/tubes, capsule intact
1C: 1A or 1B with:
1C1: surgical spill
1C2: capsule ruptured or tumor on surface
1C3: positive washings
Ovarian cancer
Stage 2
Spread to pelvis
2A: uterus
2B: other pelvic intraperitonral tissues
Ovarian cancer stage 3
Peritoneal implants outside the pelvis or positive nodes
3A: positive retroperitoneal nodes and/or microscopic spread outside the pelvis
3B: peritoneal spread <2 cm +or- nodes
3C: peritoneal spread >2cm +or- nodes
Ovarian cancer stage 4
4A: pleural effusion +cytology
4B: parenchyma disease or extra-abdominal disease
DDX FOR solid tumors
Fibrous Thecoma Fibroid Granulosa cell tumor Dysgerminoma Brenner tumor
Cystic tumors
Functional cysts
Serous and mucinous tumors
Mature teratoma
Endometrial cancer
Stage 1
Stage 2
Stage 1A: <1/2 myometrial invasion
Stage 1B: >1/2 myometrial invasion
Stage 2: cervical stroma
Endometrial cancer
Stage 3
Stage 4
3A: serosal or adnexal involvement
3B: vaginal involvement
3C: positive pelvic or para-aortic LNs
4A: bladder and/or rectum
4B: distant metS
Complete vs partial mole
Complete 46XX or 46 XY No fetus Theca lutein cysts 15% GTN
Partial
69XXX OR 69XXY
fetus present
3% GTN
Bad prognostic factors for GTN
>4 mo since pregnancy Pretreatment HCG >40000 Mets to liver and brain Preceded by term pregnancy instead of ab Previous therapy failed
Treatment for GTN
Single agent MtX vs actinomycin D for low risk dz
EMA CO for high risk dz (etoposide, MTX, actinomycin D, cyclophosphamide and vincristine
Causes of cancer death in US women
Lung Breast Colon Pancreas Ovary
Histopathology Ovarian tumors 1. Brenner 2. Dysgerminoma 3. Struma ovarii 4. Granulosa cell tumor 5. Krukenburg tumor 6. Endodermal sinus/yolk sac tumor 7. Serous tumors, low malignant potential tumors
- Coffee bean nuclei, island of transitional epithelium
- Lymphocytes
- Single germ cell layer containing thyroid tissue
- Call Exner bodies (Starry sky appearance), coffee bean nuclei
- Signet ring cells
- Schiller Duvall bodies
- Psammoma bodies
Subtypes of epithelial ovarian cancer
Serous High grade or a low-grade
Clear cell
Endometrioid
Mucinous
Risk of breast and ovarian cancer in BRCA1
BRCA2
BRCA 1
Breast 60%
Ovarian 40%
BRCA 2
Breast 50%
Ovarian 15%
Which genes warrant risk reducing BSO?
BRCA 1&2
Lynch syndrome
BRIP1
RAD 51C&D
Screening for BRCA carriers age 25-29
>30
Clinical breast exam q6mo
Breast MRI annually
Annual mammo and annual breast MRI staggered q6mo
Chemoprohylaxis in breast cancer
Tamoxifen for BRCA2. Doesn’t work for a BRCA1 (likely because of negative receptor status)
Side effects of tamoxifen
Raloxifene
VMS
vaginal dryness
VTE
endometrial cancer
VTE
LEG cramps
Dyspareunia
Weight gain
Type 2 endometrial cancers
Clear cell
Papillary serous
Risk factors for endometrial cancer
DM
OBESITY
HTN
Smoking increases risk for type 2 only
Pelvic LNs
Para-aortic LNs
Removal of nodal tissue from distal half of common iliac
Distal IVC from level of IMA to right common iliac artery
