GYN Oncology Flashcards
When should you stop ordering mammograms?
No consensus - most groups say after 70-75 reasonable to stop if patient wants, but should discuss with patient. You should still offer every year if patient has life expectancy of 10 more years and wants to do it
What are some high risk screening groups for breast cancer? When do you screen them?
BRCA1,2, PTEN mutation (Cowden), P53 (Li Frameuni), hx of thoracic/chest radiation, >20% lifetime hx of breast cancer
LCIS/atypical breast hyperplasia
Annual breast MRI + mammo, clinical breast exams twice per year, start 10yr before earliest relative OR 25yo
Describe the BIRADS classification system
0 - additional imaging needed 1 - negative 2 - benign 3 - likely benign but short term f/u needed usually in 6 months 4 - suspicious, should consider biopsy 5 - highly suggestive of malignancy
What are prognostic factors for breast cancer? What factors determine adjuvant treatment?
Nodal status and tumor size
Others: hormone receptor status, oncogene expression
Side effects of tamoxifen; when do you do US and endometrial biopsy?
VTEs, hot flashes, endometrial hyperplasia
REDUCTION of fractures
No benefit of surveillance US
All AUB/PMB should receive endometrial biopsy REGARDLESS of endometrial thickness
What are AIs? How do they work? What are some examples? Who are candidates? What are their side effects? Do they work better than tamoxifen
Aromatase inhibitors - block aromatase which converts androstenedione to estrone
Examples - letrozole and anastrazole
Patient NEEDS to be post-menopausal
Side effects: hot flashes, INCREASED fracture risk and arthralgias
NO VTE risk
**Patients on letrozole should have yearly DEXA scans
Yes, better survival than tamoxifen for ER+ breast cancers
What are the three broad categories of ovarian cancer?
- Epithelial –> Type 1 (papillary serous), Type 2 (endometrioid, clear cell)
- Sex cord (Leydig-Sertoli, granulosa)
- Germ cell (dysgerminoma, embryonal, yolk sac, choriocarcinoma, immature teratoma)
Differentiate between BRCA1 and BRCA2 (chance of cancer, chromosome location, recommendation of timing for BSO)
BRCA1 - chromosome 17, breast cancer 70%, ovarian cancer 40%, remove ovaries by 35-40yo after childbearing
BRCA2 - chromosome 13, breast cancer 70%, ovarian cancer 20%, remove ovaries by 40-45yo after childbearing
What are the various cancer risks for HNPCC? What are the screening/treatment guidelines?
Colon 70%, endometrial 40%, ovarian 10%
Start colonoscopies yearly at 25yo
Annual US, endobx, CA125 at 30-35yo
Hysterectomy/BSO in mid-40s when done w/ childbearing
GYN ONC referral guidelines for pre- and post- menopausal women
Pre-menopausal: CA125>200, first deg family relative w/ breast or ovarian cancer, ascites, evidence of mets
Post-menopausal: CA125>35, first deg family relative with breast or ovarian cancer, ascites, evidence of mets, fixed nodular pelvic mass
How do you treat an immature teratoma?
USO on affected side w/ surgical staging; stage IA grade I does not require adjuvant therapy, every other stage needs chemotherapy (BEP)
How do you perform correct surveillance on someone status post surgery for endometrial cancer?
Pelvic exam q3-6 months x 2 years, then every 6 months yearly (speculum and bimanual exam)
What are the Amsterdam criteria?
What are the Bethesda criteria?
Used to identify who should be screened for HNPCC
3 or more relatives with an HNPCC-associated cancer (colorectal cancer, or cancer of the endometrium, small intestine, ureter or renal pelvis);
2 or more successive generations affected;
1 or more relatives diagnosed before the age of 50 years
Bethesda - anyone with CRC under 50yo should be screened for Lynch syndrome
Differentiate a partial and complete mole (villous edema, fetal tissue presence, karyotype, risk of GTN cancer)
Partial - contains fetal tissue, 69-XXX, 69-XXY, or 69-XYY (TRIPLOID), lower risk of malignancy, focal/less villous edema
Complete - no fetal tissue, DIFFUSE villous edema, normal karyotype (46XX, 46XY - all chromosomes are paternally derived), has a very high malignant potential
What are some 4 point values for the WHO criteria?
What is considered a low risk and high risk number?
Interval of >13mo from index pregnancy, pre-treatment HCG of >100,000, brain/liver mets, mets > #8
Low risk score < 6; single agent chemo
High risk score >= 7, multi agent chemo
