Gynae Onc Flashcards
Endometrial ca - Incidence
2.5% lifetime risk
Most common gynae malignancy in developed countries (second to cervix in developing countries)
Endometrial cancer - Risk factors (Type I)
Endometrioid (80%)
- Obesity
- Increased oestrogen exposure
- Tamoxifen
- HNPCC
- PCOS
Endometrial cancer - Risk factors (Type II)
Serous/clear cell/mucinous (20%)
- Age
- Tumour mutations and aneuploidy
- Possibly obesity
Endometrial cancer - Symptoms
90% PMB (10% of PMB is ca)
Pelvic pressure secondary to enlarging uterus
Haematometra/pyometra
Asymptomatic <5% - pap smear, conincidental imaging finding, hysterectomy for other cause
Endometrial cancer - Survival
Overall 75%
75% are stage 1
Endometrial cancer - Role of screening
No role in women without HNPCC
Most women have symptoms at an early stage
With HNPCC - ~50% lifetime risk endo ca (and 10% ov), so yearly TV USS and endo sampling from 30 or 5y younger than youngest affected relative
Endometrial hyperplasia and progression to malignancy
Simple 1% Complex 3% Simple w atypia 8% Complex w atypia 30% - if ca coexistent risk coexistent ov ca (5%PM, 25% preteen)
Endometrial cancer types
Endometrioid 80% Mucinous 5% Clear cell 5% Papp serous 3% Squamous Rare Simulatenous w ovary 1-3% (most well differentiated with good prognosis)
FIGO Staging Endometrial Ca
1a 50% myometrial invasion
2 cx stroma but not beyond uterus
30% 5y
3a/b local spread
3c nodal spread (pelvic or paraaortic)
10% 5y
4a bladder/bowel
4b distant mets or inguinal LN
Endometrial cancer - Prognostic factors
Good prognosis:
- Young age
- Endometrioid type
- Low grade
- Small size
- ER/PR +
- Diploid
- No myometrial invasion
Difference complete vs partial molar pregnancy
COMPLETE:
- Usually diploid (usually all paternal 46XX)
- 25% chance persistent trophoblastic disease
- usually no foetal parts
PARTIAL:
- Usually triploid (69XXY, 69XXX)
- May have foetal parts
- 1-2% risk persistent trophoblastic disease
Types of persistent trophoblastic disease
Choreocarcinoma = malignant transformtation of molar tissue or de novo after normal pregnancy
Palcental site tumour = increasedhumal placental lactogen
Epithelioid trophoblastic tumour
Vulval cancer
- Incidence
- Age group
- Type
2/100 000
Bimodal distribution - older w LS, younger w HPV
Types: (90% are primary, 10% mets)
- 90% Squamous
- 5% Melanoma
- 3% adenocarcinoma (Bart’s and Bechet’s)
- Other BCC and sarcoma
Vulval cancer - Risk factors
Age Lichen sclerosis Smoking HPV Previous gynaecological malignancy VIN Paget’s disease
Vulvar cancer - metastatic pattern
30 % metastatic at the time of diagnosis
Nodes: inguinofemoral > pelvic
Local
Haematogenous
Vulval cancer - Rx
Individualised
1mm depth of invasion then LN assessment (if 4cm groin dissection)
2cm rule:
- cut a 2cm margin
- if >2cm then consider bilateral nodes
- with within 2cm of the midline consider bilateral nodes
VIN - Types
- Usual type
- HPV related
- <30y
- 95%
- warty/basaloid - Differentiated type
- LS
- 5%
- High rate of progression to ca (?100%)
- older women
Vulval melanoma
Staged with Clark levels and Breslow thickness Most > 50y Worse prognosis than other types No role for CTx ? role of interferon
Vulval adenocarcinoma
Majority arise in Bartholin’s gland Homan’s criteria for diagnosis - Correct anatomical location - deep to labia major - overlying skin is intact - Recognisable residual gland Rx: - Radical excision and LN (inguinofemoral) - primary RTx if fixed to underlying structure