Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN 4MB > Gynae Malignancy: Endometrial and Ovarian Cancer > Flashcards

Gynae Malignancy: Endometrial and Ovarian Cancer Flashcards

1
Q

What is the epidemiology of endometrial cancer?

A
  • Most common gynaecological cancer
  • Prevalence highest at 60yrs
  • Usually presents early
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the types and characteristics of endometrial cancer

A
  1. Type 1:
    - Majority
    - Low-grade
    - Oestrogen sensitive
    - Obesity associated
    - Less aggressive
  2. Type 2:
    - High-grade endometroid, clear cell, serous or carcinosarcoma
    - More aggressive
    - Not oestrogen sensitive
    - Not related to obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the risk factors for development of endometrial cancer

A
  1. EXPOSURE TO EXOGENOUS AND ENDOGENOUS OESTROGENS:
    - Obesity
    - Diabetes
    - Early menarche
    - Nulliparity
    - Late menopause
    - Older age (>55)
    - Unopposed oestrogen HRT
    - Tamoxifen
  2. Lynch syndrome (HNPCC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are protective factors against endometrial cancer?

A
  1. Combined oral contraceptive pill

2. Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What causes endometrial hyperplasia with atypia?

A
  • Unopposed oestrogen = hyperplasia of the endometrium
  • Further stimulation = abnormalities of cellular architecture
  • Hyperplasia with atypia can coexist with carcinoma elsewhere in the uterine cavity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does endometrial hyperplasia with atypia present?

A

Presents with menstrual abnormalities or postmenopausal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for endometrial hyperplasia with atypia?

A
  1. Hysterectomy
  2. If fertility a concern:
    - Progestogens
    - 3-6mthly hysteroscopy and endometrial biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the clinical features of endometrial carcinoma

A
  1. History:
    - Postmenopausal bleeding (most common)
    - Intermenstrual bleeding
    - Recent onset menorrhagia

*Last two for pre-menopausal women

  1. Examination:
    - Pelvis normal
    - Atrophic vaginitis may coexist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does endometrial carcinoma spread?

A
  1. Direct spread - through myometrium to cervix and upper vagina
  2. Lymphatic spread - Pelvic and para-aortic lymph nodes
  3. Blood borne spread - late disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is endometrial carcinoma staged?

A

Stage 1 = confined to the uterus
Stage 2 = Cervix also involved
Stage 3 = Tumour invades though uterus (local spread)
Stage 4 = Distant metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do we investigate abnormal vaginal bleeding?

A
  1. TVUS (to exclude local structural causes in pre-menopausal women; postmenopausal women to measure endometrial thickness)
  2. Endometrial biopsy +/- hysteroscopy (only considered in pre-menopausal women >40yrs, not responsive to medical therapy, younger women with risk factors for endometrial cancer; postmenopausal women with endometrial thickness >4mm)
  3. Chest x-ray
  4. Assess fitness for surgery:
    - FBC
    - Renal function
    - Glucose testing
    - ECG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the surgical management of endometrial carcinoma?

A
  • Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy
  • Routine lymphadenectomy not beneficial in early stage disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What adjuvant therapies can be used in endometrial carcinoma?

A
  1. External beam radiotherapy:
    - Used following hysterectomy in patients with, or considered ‘high risk’ for lymph node involvement
    - Indications - deep myometrial spread, poor tumour histology or grade, cervical stromal involvement
  2. Vaginal vault radiotherapy:
    - Decreases local recurrence but does not prolong survival
  3. Chemotherapy:
    - In high risk and advanced cases
  4. Progestogens (seldom used now)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the prognosis of endometrial carcinoma and list the poor prognostic features?

A
  • Recurrence most common at vaginal vault in first 3yrs
  • Poor prognostic factors:
    1 Older age
    2 Advanced clinical stage
    3 Deep myometrial invasion
    4 High tumour grade
    5 Adenosquamous histology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do we classify ovarian tumours?

A
  1. Primary neoplasms
  2. Secondary malignancies (breast, GI, 10% of malignant ovarian masses)
  3. Tumour-like conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Classify primary ovarian neoplasms

A

Benign:

  1. Epithelial tumours:
    * Brenner tumours
  2. Germ cell tumours:
    * Teratoma or dermoid cyst
  3. Sex cord tumours:
    * Thecoma
    * Fibroma

Malignant:

  1. Epithelial tumours:
    * Serous cystadenoma or adenocarcinoma
    * Endometrioid carcinoma
    * Clear cell carcinoma
    * Mucinous cystadenoma or adenocarcinoma
  2. Germ cell tumours:
    * Yolk sac tumour
    * Dysgerminoma
  3. Sex cord tumours:
    * Granulosa cell tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are epithelial tumours?

A
  • Derived from epithelium covering the ovary and fallopian tube
  • Most common in postmenopausal women
  • May become frankly malignant
  • Surgery advised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List the key points about serous cystadenoma or adenocarcinoma of the ovary

A
  1. Epithelial tumour
  2. Most common malignant ovarian neoplasm
  3. High grade or low grade
  4. Benign and ‘borderline’ forms also exist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the key points about endometrioid carcinoma of the ovary

A
  1. Epithelial tumour
  2. 10% of ovarian malignancies
  3. Similar histologically to endometrial carcinoma
20
Q

List the key points about clear cell carcinoma of the ovary

A
  1. Epithelial tumour
  2. 10% of ovarian malignancies
  3. Poor prognosis
21
Q

List the key points about mucinous cystadenoma or adenocarcinoma of the ovary

A
  1. Epithelial tumour
  2. Can become very large
  3. 3% of ovarian malignancies
22
Q

List the key points about Brenner tumours

A
  1. Epithelial tumour
  2. Rare
  3. Usually small and benign
23
Q

What are germ cell tumours?

A
  • Originate from undifferentiated primordial germ cells of the gonad
  • 3% of ovarian malignancies
24
Q

List the key points about teratomas and dermoid cysts

A
  1. Germ cell tumours
  2. Benign
  3. Young, pre-menopausal women
  4. May contain fully differentiated tissue of cell lines
  5. Commonly bilateral
  6. Seldom large
  7. Asymptomatic
  8. Can rupture
  9. Malignant form = solid teratoma (rare)
25
Q

List the key points about yolk sac tumours

A
  1. Germ cell tumour
  2. Highly malignant
  3. Children or young women
26
Q

List the key points about Dysgerminomas

A
  1. Germ cell tumour
  2. Most common ovarian malignancy in younger women
  3. Sensitive to radiotherapy
27
Q

What are sex cord tumours?

A
  • Originate from the stroma of the gonad

- <2% of ovarian malignancies

28
Q

List the key points about granulosa cell tumours

A
  1. Sex cord tumour
  2. Malignant but slow growing
  3. Rare
  4. Postmenopausal women
  5. High levels of oestrogens and inhibin
  6. Can cause bleeding, endometrial hyperplasia, endometrial malignancy and precocious puberty
29
Q

List the key points about thecomas

A
  1. Sex cord tumour
  2. Rare
  3. Usually benign
  4. Secret oestrogens and/or androgens
30
Q

List the key points about fibromas

A
  1. Sex cord tumours
  2. Rare and benign
  3. Can cause Meig’s syndrome - ascites and pleural effusion found with small ovarian mass
  4. Effusion benign and cured by removal of mass
31
Q

List the tumour-like conditions of the ovary

A
  1. Endometriotic cyst

2. Functional cysts

32
Q

List the key points about endometriotic cysts of the ovary

A
  1. Tumour-like condition
  2. Altered blood accumulates in chocolate cysts
  3. Called endometrioma
  4. Can rupture = very painful and uncommon
33
Q

List the key points about functional cysts of the ovary

A
  1. Tumour-like condition
  2. Follicular cysts and lutein cysts = persistently enlarged follicles
  3. Only pre-menopausal women
  4. COCP is protective
  5. Lutein cysts cause more symptoms
  6. Functional cyst >5cm persists beyond 2mths = CA125 measured (remote possibility of malignancy)
34
Q

List some key points about ovarian cancer

A
  1. Presents late
  2. Widely metastatic at presentation
  3. 10yr survival 40-50%
  4. Lifetime risk 1 in 60
  5. Rates increase with age
  6. COCP decreases risk
  7. 95% epithelial tumours
  8. Germ cell tumours most common <30yrs
35
Q

What are the aetiological factors with ovarian cancer?

A
  1. Benign cysts can undergo malignant change
  2. Risk factors:
    * Early menarche
    * Late menopause
    * Nulliparity
  3. Protective factors:
    * Pregnancy
    * Lactation
    * COCP
  4. Familial factors:
    * 5%
    * BRCA1, BRCA2 or HNPCC
    * BRCA1 = 50% risk
    * Women with family hx offered BRCA testing
36
Q

What features are present in the history of a woman with ovarian cancer?

A
  1. Initially vague symptoms
  2. Persistent abdominal distension
  3. Early satiety and/or loss of appetite
  4. Pelvic or abdominal pain
  5. Urinary urgency or frequency
  6. Breast and GI symptoms (mestastatic)
37
Q

What features are present on examination of a woman with ovarian cancer?

A
  1. Cachexia
  2. Abdominal or pelvic mass (very large likely malignant)
  3. Ascites
  4. Palpate the breasts
38
Q

How does ovarian cancer spread?

A
  1. Direct spread
  2. Lymphatic spread
  3. Blood borne
39
Q

How is ovarian cancer staged?

A
  • FIGO staging

- Surgical and histological

40
Q

What initial investigations should be done to detect ovarian cancer?

A
  1. CA 125 levels in women >50yrs with many abdominal symptoms
  2. If CA 125 > 35IU/ml perform abdominal US and pelvic US
41
Q

What investigations are used to establish a diagnosis of ovarian cancer?

A
  1. Women <40yrs measure levels of alpha fetoprotein (AFP) and hCG - to identify germ cell tumours
  2. Risk of malignancy index - product of the US score (U), menopausal status (M) and serum CA 125 level
  3. Biopsy
42
Q

How is ovarian cancer managed?

A
  1. Surgical management:
    * Midline laparotomy allows thorough assessment of abdomen and pelvis
    * TAH + BSO + partial omentectomy with biopsies of any peritoneal deposits, random biopsies of peritoneum and retroperitoneal lymph node assessment
    * Prognosis relates to effectiveness of procedure
  2. Chemotherapy:
    * Need confirmed tissue diagnosis
    * High grade, stage 1c - six cycles of carboplatin (platinum)
    * Stage 2-4 - carboplatin or cisplatin alone or in combination with paclitaxel
    * 2/3 relapse
    * Many receive neoadjuvant chemo and have surgery half way through course
43
Q

What follow up is need in ovarian cancer?

A
  1. Levels of CA 125
  2. CT scanning for residual disease
  3. Interval debulking of residual tissue
  4. Chemo - prolongs short term survival and improves quality of life
44
Q

List the poor prognostic indicators in ovarian cancer

A
  1. Advanced stage
  2. Poorly differentiated tumours
  3. Clear cell tumours
  4. Slow or poor response to chemo
45
Q

What other things should be offered to ovarian cancer patients?

A

Offer support and written information

OBGYN 4MB (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions