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Oncology boards > Gyn Onc > Flashcards

Gyn Onc Flashcards

1
Q

Management of early stage cervical cancer in general

A
  • Early stage cervical cancer.
    Upfront surgery (cervical conization vs. modified radical vs. radial hysterectomy depending on stage)
  • ***Adjuvant chemoradiation if path indicates intermediate or high-risk of recurrence
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2
Q

Surgical management of stage I cervical cancer

A

IF IA1, conization w/ no further management if margins negative
IF IA2,
modified radical hysterectomy (removal of uterus, cervix, upper ¼ of vagina, and paramteria)
simple hysterectomy w/ lymphadenectomy (can get away with simple hysterectomy)
IF IB1, radical hysterectomy w/ lymphadenectomy
IF IB2, radical hysterectomy

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3
Q

First line for MMR deficient advanced endometrial

A

carbo/taxol/durvalumab w/ maintenance durvalumab until progression (DUO-E - PFS HR 0.42 in dMMR, OS immature)
*or dostarlimab w/ maintenace dostarlimab

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4
Q

Size threshold for surgery vs. CRT

A

4 cm (greater than 4 cm requires CRT)

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5
Q

CRT for cervical

A

weekly cisplatin w/ EBRT + brachytherapy

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6
Q

Indications for adjuvant chemoradiation in localized cervical

A
  • positive margins
  • node positive
  • parametrial invasion
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7
Q

Metastatic cervical mgmt

A

IF PD-L1 positive, platinum/carboplatin + paclitaxel + pembro +/- avastin
IF PD-l1 negative, platinum/taxol and bev

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8
Q

endometrial cancer presentation

A
  • pelvic pain
  • change in bowel habits
    *vaginal bleeding
  • discharge
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9
Q

endometrial cancer RF’s

A
  • obesity
  • HRT
  • tamoxifen
  • older age
  • infertility
    *endometrial hyperplasia
    *PCOS
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10
Q

Management of complex atypical hyperplasia

A

hysterectomy

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11
Q

Lynch recommended endometrial cancer screening

A
  • transvaginal US annually starting at age 30
    *Risk reducing hysterectomy with BSO at 35 or after completing childbearing
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12
Q

endometroid significance with endometrial

A
  • bread and butter, more common endometrial cancer
  • nonendometroid is higher risk
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13
Q

Uterine serous cancer significance

A
  • aggressive, “serious”
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14
Q

Stage 1A endometrial management in woman wishing to preserve fertility

A
  • IF G1-2, hormone therapy with medrestol (oral progestin) can be used to preserve fertility
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15
Q

Stage II endometrial mgmt

A

upfront surgery / adjuvant full pelvic EBRT

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16
Q

Stage III-IV endometrial mgmt

A
  • upfront surgery
  • adjuvant chemo
    *CRT also an option followed by chemo for Stage III
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17
Q

clear cell significance in endometrial

A
  • aggressively behaving, requires systemic therapy
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18
Q

serous HER2+ endometrial cancer mgmt

A
  • add herceptin to carbo/taxol
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19
Q

recurrent metastatic endometrial mgmt

A

IF treatment free interval of >6 months, retreat with carbo/taxol

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20
Q

Systemic therapy for uterine carcinosarcoma

A

ifosfamide or platinum-based therapy or taxol

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21
Q

low grade endometrial stromal sarcoma mgmt

A
  • hormonal therapy medregstrol
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22
Q

leiomyosarcoma mgmt

A

surgery if resectable

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23
Q

stage IB cervical cancer mgmt

A

surgery with adjuvant brachytherapy (not full pelvic EBRT)

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24
Q

ovarian cancer presentation

A
  • bloating
  • pelvic or abdominal pain
  • early satiety
  • urinary symptoms
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25
Q

ovarian cancer RF’s

A
  • obesity
  • ## estrogen exposure (later pregnancy after age 35)
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26
Q

When germline BRCA testing is indicated in ovarian

A

All high grade ovarian

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27
Q

Ovarian cancer biomarker

A

CA-125

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28
Q

Stage I ovarian cancer mgmt

A

IF wishing to preserve fertility, salpingo-oophorectomy

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29
Q

general management of ovarian

A

upfront cytoreductive surgery w/ salpingo-oophorectomy and hysterectomy w/ adjuvant chemo

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30
Q

management of ovarian in nonsurgical patient

A

upfront systemic therapy

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31
Q

When adjuvant chemo is indicated in ovarian

A

1) Stage IC or higher (positive ascites or peritoneal washings)
2) G3
3) clear cell histology

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32
Q

Role of maintenance in ovarian

A

*Essentially PARP + avastin for anyone regardless of BRCA status if high risk for recurrence
*PARP if not high risk for recurrence
*So PARP maintenance for all and avastin if high risk for recurrence

33
Q

niraparib SE

A

thrombocytopenia

34
Q

Recurrent metastatic ovarian management

A

IF platinum sensitive, carbo/taxol +/- bev
*second cytoreductive surgery if possible
IF platinum resistant, liposomal doxorubicin + avastin
IF no trial, alternative chemo - docetaxel, pemetrexed, doxorubicin

35
Q

sensitivity to immunotherapy in ovarian

A
  • not very effective
36
Q

serous ovarian low grade management

A
  • AI
  • MEK inhibitors
37
Q

mucinous ovarian cancer mgmt

A
  • GI regimens (platinum resistant), eg. mFOLFOX
38
Q

ovarian dysgerminoma mgmt

A
  • analogous to seminoma (BEP)
39
Q

ovarian yolk sac (endodermal sinus) of ovary 1) characteristic path finding 2) mgmt

A
  • schiller duval bodies
  • adjuvant BEP
40
Q

immature teratoma of ovary mgmt

A
  • adjuvant BEP
41
Q

granulosa cell tumor of ovary of mgmt

A
  • upfront surgery
  • BEP
42
Q

sertoli-leydig tumor of ovary 1) presentation 2) mgmt

A

1) virilization (testosterone producing - opposite of male sertoli-leydig)
2) surgery w/ adjuvant BEP

43
Q

Ethnicity with highest rising rate of endometrial cancer

A

Black

44
Q

endometrial cancer RF’s

A

obesity
tamoxifen
Unopposed estrogen therapy
infertility
*PCOS (increased estrogen production)
Estrogen-producing ovarian tumors

45
Q

Lynch genes mutated in majority of endometrial cancer pts

A

MLH1 + MSH2

46
Q

Indication for MSI/MMR in endometrial cancer patients

A

All patients (universal screening)

47
Q

Management of endometrial complex atypia

A
  • treated as malignancy (high percentage have coexisting adenocarcinoma)
48
Q

Management of endometrial in patients who aren’t surgical candidates

A

XRT

49
Q

Adjuvant management stage I endometrial management

A
  • indicated for high grade disease
  • Brachytherapy vs. radiotherapy depending on depth of invasion (full pelvic if deep invasion)
50
Q

Stage III endometrial mgmt

A
  • cytoreductive surgery
  • adjuvant chemo +/- XRT
51
Q

Management of endometrial with isolated vaginal/pelvic recurrence

A

XRT

52
Q

Later line for endometrial post chemo

A

Lenvatinib + pembro

53
Q

When VEGF addition is indicated in endometrial

A

p53 mutation in recurrent metastatic disease

54
Q

Targetable mutation for first line endometrial

A

HER2 for Serous endometrial

55
Q

Localized carcinosarcoma mgmt

A

Surgery with adjuvant carbo/taxol (noninferior to ifosfamide and better tolerated)

56
Q

Management of endometrial stromal sarcoma

A

Hormonal therapy (megestrol acetate) - hormone sensitive

57
Q

Gyn malignancy assocaited with diethylstilbestrol (DES) exposure in utero

A

clear cell adenocarcinoma of the vagina and cervix

58
Q

Preferred firstline systemic therapy for low grade endometrial stromal sarcoma

A
  • AI
59
Q

Olaparib SE to know

A

pneumonitis

60
Q

Rucaparib SE to know

A

hepatotoxic

61
Q

Management of ovarian cancer pt in surveillance with rising CA 125

A
  • PET or CT
62
Q

Components of surgical staging for ovarian cancer

A
  • omentectomy, peritoneal biopsies, + lymph node sampling
63
Q

Molecular profiling of endometrial

A
  • MSI/MMR
    *HER2
64
Q

Status of HER2 in endometral

A

Added to systemic therapy in first line metastatic setting if HER2 positive

65
Q

Management of stage II cervical cancer (extension beyond the uterus)

A

Concurrent chemoradiation (w/ EBRT), followed by brachytherapy

66
Q

First line for low risk gestational trophoblastic neoplasm/choriocarcinoma

A
  • single agent chemo with methotrexate or dactinomycin
67
Q

first line for metastati uterine leiomyosarcoma

A

gemcitabine + docetaxel
Doxorubicine + trabectedin (Preferred)

68
Q

1) RF’s for ovarian cancer 2) protective factor

A

1) Nulliparity and early menarche
2) OCP’s

68
Q

Cervical cancer screening

A

High risk HPV test q 5 yrs (preferred) starting at age 25
- HPV + cytology cotesting q 5 years also an option

69
Q

Management of locally advanced small cell carcinoma of the cervix

A
  • CRT with cisplatin and etoposide, followed by 2 additional cycles of cisplatin/etoposide
    *essentially the same as small cell of lung
70
Q

Management of metastatic cervical with peritoneal carcinomatosis

A
  • intraperitoneal cisplatin/taxol + IV taxol
71
Q

Drug approved for ovarian with tumors expressing high levels of FOLR1

A

mivretuximab soravtansine

72
Q

Tumor mutational profiling required for metastatic cervical cancer

A

PD-L1 (IO added to chemo for PD-L1 positive)

73
Q

Gene mutation to know for granulosa cell tumors

A

FOXL2

74
Q

Initial management of cervical cancer with pelvic wall extension and hydronephrosis

A

Concurrent CRT w/ platinum chemo followed by brachytherapy

75
Q

Stage IA dysgerminoma management

A

Observation

76
Q

Minimally invasive/robotic vs. open hysterectomy for small cervical tumors

A

open (minimally invasive associated with lower OS)

77
Q

Recurrent metastatic cervical cancer management

A

same as de novo, platinum sensitivity doesn’t apply (CONFIRM)

Oncology boards (41 decks)

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