Gyn onc Flashcards
Most common type of cervical cancer
Squamous cell carcinoma, 70-75%
Favorable prognosis with early detection and treatment
Second most common cervical cancer
Adenocarcinoma, 25%
Favorable prognosis with early detection and treatment
Mostly associated with HPV16 (more oncogenic)
Type 2 endometrial CA
10-20% of EC
- Clear cell/papillary serous, high grade with poor prognosis
- risk factors: smoking, non-white, age, underweight
- arises in atrophic endometrium
Stage IA-B uterine sarcoma
Limited to uterus
A: 5 cm or less in diameter
B: >5 cm
Stage IIA-B uterine sarcoma
Extends beyond uterus within pelvis
A: adnexa
B: other pelvic tissues
Stage IIIA-C uterine sarcoma
Infiltrates abdominal tissues
A: one site
B: more than one site
C: Regional lymph node mets (para-aortic/pelvic)
Stage IVA-B uterine sarcoma
Tumor spreads to distant sites
A: bladder/rectum
B: distant mets
BRCA1 cancers, chromosome
Chromosome 17 (DNA repair)
breast, ovarian, prostate
BRCA2 cancers, chromosome
Chromosome 13 (DNA repair)
breast, ovarian, prostate, melanoma, pancreas
Lynch genes and cancers
MLH1, MSH2/6, PMS2, EPCAM (DNA mismatch repair)
Ovarian, endometrial, colon, gastric, ureteral, biliary, pancreatic, glioblastoma, renal pelvic
Li-Fraumeni
TP53, breast and colon CA
tumor suppressor
Cowden
PTEN
Breast, endometrial, colon, GI hamartomas
Indication for radical hyst
Stage 1B1-1B2 (sometimes 1B3 and IIA1)
Type C1 = nerve sparing, C2 = not nerve sparing
Uterine artery divided at medial aspect of internal iliac
Psammoma bodies
Papillary serous CA
Concentric rings of calcifications
- Serous cystadenoCA of ovary, serous endometrial CA (10% of endometrial CA, type 2)
Hobnail cells
Clear cell endometrial CA (similar to ovarian clear cell), 5% of endometrial CA, type 2
Type 1 endometrial CA genes
PTEN, KRAS, Lynch, ER+
5y survival with type 1 endometrial CA up to 85%
Type 2 endometrial CA genes
p53
Choriocarcinoma tumor marker
hCG
Dysgerminoma tumor marker
LDH, hCG
Embryonal tumor marker
hCG, AFP
Endodermal sinus/yolk sac tumor marker
AFP
Epithelial tumor marker
CA125
Granulosa tumor marker
Inhibin
Mucinous tumor marker
CEA
Sertoli-Leydig cell tumor symptoms/findings
Sex cord stromal tumor that secretes testosterone
- 75-85% of pts report the following: oligo/amenorrhea, breast atrophy, acne, hirsutism, clitoromegaly, deep voice, receding hairline
Choriocarcinoma tumor marker
hCG
Immature teratoma tumor marker
AFP, LDH, CA125
Schiller Duval bodies
Endodermal sinus tumor
Call Exner bodies
Granulosa cell tumor
Reinke crystals
Leydig cell tumors
Hobnail cells
Clear cell CA
Psammoma bodies
Serous cystadenoma
Signet ring cells
Krukenberg tumors
Stage 1A-B ovarian CA staging
1A: one ovary or tube
1B: both ovaries or tubes
Stage 1C1-3 ovarian CA staging
Cancer in one or both ovaries/tubes, can now be found on surface
1C = chemo
1C1: surgical spill
1C2: capsule rupture before surgery
1C3: found in ascites washings after surgery
Stage 2A-B ovarian CA staging
2A: spread to uterus
2B: spread to sigmoid/rectum/bladder
Stage 3A-C ovarian CA staging
3A1: primary peritoneal or spread to pelvic/para-aortic nodes
3A2: spread above pelvic brim
3B: spread to abdominal organs, up to 2 cm lesions
3C: capsule of liver/spleen, >2cm
Stage 4A-B ovarian CA staging
4A: pleural effusion
4B: organs outside abdomen/pelvis
Stage 1A-B endometrial CA
Confined in uterus
1A: <50% of myometrial thickness
1B: >50% myometrial thickness
Stage 2 endometrial CA
Spread to cervix but still confined within uterus
Stage 3A-C endometrial CA
Spread outside uterus but not to rectum/bladder
3A: ovary/uterine serosa
3B: vagina/parametrium
3C1: pelvic nodes
3C2: para-aortic nodes
Stage 4A-B endometrial CA
4A: bladder/rectum/bowel mets
4B: mets to other organs
Stage 1A1-2 cervical CA
Microscopic invasion confined to cervix
1A1: 3mm or less
1A2: >3-5 mm
1A1 managed with cone or simple hyst
1A2 managed with modified radical or radical hyst
Stage 1B1-3 cervical CA
Deeper invasion than 5mm but confined to cervix
1B1: >5 mm up to 2 cm
1B2: >2 cm up to 4 cm
1B3: >4 cm
Managed with radical hyst (above this managed with chemoradiation)
Stage 2A-B cervical CA
Growth outside cervix/uterus but not pelvis or lower vagina
2A: upper 2/3 vagina
2B: parametrium
Managed with cisplatin and radiation (stage 2-4A)
Stage 3A-C cervical CA
Spread to lower vagina or pelvic sidewall
3A: lower 1/3 vagina
3B: pelvic sidewall/hydronephrosis
3C: involves pelvic (3C1)/paraaortic nodes (3C2)
Stage 4A-B cervical CA
Spread to bladder, rectum, distant organs
4A: rectal/bladder mucosa, can still be managed with chemoradiation
4B: further mets, managed with palliative chemoradiation
Vulvar CA prognostic factors
Most important is lymph node involvement
- Node negative: 70-93% 5y survival
- Node positive: 25-41% 5y survival
Stage I vaginal CA
Limited to vaginal wall
Stage II vaginal CA
Invades paravaginal tissue, not pelvic sidewall
Stage III vaginal CA
Extends to pelvic sidewall, does not invade other pelvic organs
Stage IVA-B vaginal CA
Extends beyond true pelvis or involves bladder/rectum mucosa
A: bladder/rectum or direct extension beyond pelvis
B: distant organs
Lynch syndrome screening recommendations
- Colonoscopies starting at 20-25y q1-2y, or 2-5y before earliest cancer diagnosis in family
- breast: age 25-30 MRI q6mos, exam q6 mos. >30 MRI and mammo alternating q6mos, exam q6mos
- EMB starting at 30-35y q1-2y
- Ovarian: >30 can consider annual US with CA125
Amsterdam criteria
Used to diagnose Lynch syndrome
- 3+ relatives with Lynch-associated cancer
- Involves at least 1 first degree relative and two successive generations
- At least one diagnosed <50yo
- Exclude FAP (familial adenomatous polyposis)
BRCA carrier prophylactic BSO timing
BRCA1: 35-40yo
BRCA2: 40-45yo
