gynae onc Flashcards
AFP raised in
Immature teratoma
Sertoli leydig
Yolk sac tumor
Embryonal carcinoma
hcG raised in
dysgerminoma
embryonal carcinoma
LDH raised in
dysgerminoma
immature teratoma
ca125 raised in
epithelial tumors
CEA raised in
epithelial tumors
estradiol raised in
juvenile granulosa cell tumor
testosterone raised in
sertoli-leydig cell tumors
what tumor markers raised in IMMATURE TERATOMA
AFP
LDH
what tumor markers raised in SERTOLI LEYDIG TUMOR
AFP
Testosterone
what tumor markers raised in YOLK SAC TUMOR
AFP
what tumor markers raised in EMBRYONAL CARCINOMA
AFP
hCG
what tumor markers raised in DYSGERMINOMA
hCG
LDH
What tumor markers raised in EPITHELIAL TUMORS
CA125
CEA
what tumor markers raised in JGCT?
estradiol
major complication rate for cervical ca
27%
adverse long term bowel QoL effects reported in __% od RT pts?
50%
obstruction presents in __% RT for cervical ca
14.%%
fistula present in ___% of women undergoing single or combined treatment for cervical ca
8%
radiation cystitis incidence
26%
bladder atony - % requiring ISC
2-3%
urinary/vaginal fistula after radical hysterectomy
<2%
RT dose that may induce menopause
10Gy
dyspareunia reported in __% after RT for cervical ca
55%
endometrial ca 1y survival overall
90%
endometrial ca 5y survival overall
75%
endometrial ca 10y survival overall
70%
ovarian ca 1y survival overall
71%
ovarian ca 5y survival overall
42%
ovarian ca 10y survival overall
35%
cervical ca 1y survival overall
81%
cervical ca 5y survival overall
61%
cervical ca 10y survival overall
50%
vulval ca 1y survival overall
86%
vulva ca 5y survival overall
67%
vaginal ca 1y survival overall
90%
vaginal ca 5y survival overall
70%
endometrial ca 5y survival by stage
92, 74, 47, 15
ovarian ca 5y survival by stage
93, 67, 27, 13
cervical ca 5y survival by stage
87, 67
incidence endometrial ca
28/100 000
lifetime risk of endometrial ca
3%
10-15% for obese patients
tamoxifen increases risk of endometrial ca by
3-6x
bariatric surgery decreases risk of endometrial ca by
70-80%
NPV of ET<4mm on TVS for endo ca
> 99%
positive findings on hysteroscopy, what chance of EC
70%
negative findings on hysteroscopy, what chance of EC
2.5%
failure rate of OPD EB
7%
inadequate sample on EB
1% have EC
10% have EH or polyps
ovarian cancer incidence
9-17/100 000
lifetime risk of ovarian cancer
2%
most important prognostic indicator for ovarian cancer
volume of residual disease
staging laparotomy for ovarian cancer
1) evaluate peritoneal surfaces
2) washings or retrieve ascites
3) infracolic omentectomy
4) selective lymphadenectomy of pelvic and para-aortic nodes
5) Bx or resection of suspicious lesions
6) random peritoneal Bx
7) TAHBSO
platinum sensitive ovarian disease
relapse >12/12
platinum partially sensitive ovarian disease
relapse 6-12/12
platinum resistant ovarian disease
relapse <6/12
platinum refractory ovarian disease
does not respond
use pegylated liposomal doxurubicin, topetocan, or etoposide
ovarian staging: disease confined to ovaries or tubes
Stage I
ovarian staging: one or both ovaries or tubes, pelvic extension, or peritoneal cancer
Stage 2
ovarian staging: one or both ovaries or tubes, spread to peritoneum outside the pelvis or metastasis to retroperitoneal nodes
Stage 3
ovarian staging: pleural effusion with positive cytology
Stage 4a
ovarian staging: parenchymal mets , inguinal nodes, or extra-abdominal organs
stage 4b
ovarian staging: surgical spill
stage IC1
ovarian staging: capsule rupture
stage 1C2
ovarian staging: cells in washings or ascites
stage 1C3
ovarian staging: extension or implants onto uterus, tubes or ovaries
stage 2a
ovarian staging: extension to other pelvic intraperitoneal tissues
stage 2b
ovarian staging: positive retroperitoneal nodes only
stage 3a1
ovarian staging: peritoneal mets beyond pelvis up to 2cm in diameter
stage 3B
ovarian staging: peritoneal mets >2cm
stage 3C
ovarian staging: capsule of liver or spleen
stage 3c
endometrial staging: <50% myometrial invasion
stage 1A
endometrial staging: >50% myometrial invasion
stage 1B
endometrial staging: extension to cervix
stage 2
endometrial staging: spread to serosa/adnexa
stage 3a
endometrial staging: spread to vagina or parametrium
stage 3b
endometrial staging: pelvic nodes
stage 3C1
endometrial staging: para-aortic nodes
stage 3C2
endometrial staging: spread to bowel or bladder
stage 4a
endometrial staging: spread to groin nodes
stage 4b
cervical ca 1y survival by stage
96, 92, 74, 50
ovarian ca 1y survival by stage
98, 90, 73, 54
uterine ca 1y survival by stage
99, 95, 83, 46
vulval ca 1y survival by stage
96, 89, 78, 43
lifetime risk of cervical ca
1/135
HPV type most common in cervical ca
16 (and 18, together 75%)
age group with highest incidence of cervical ca
25-34
25-29 especially?
age group with highest incidence of endometrial ca
70-74
age group with highest incidence of ovarian ca
75-79
cervical staging: confined to cervix/uterus, <3mm in depth
IA1
cervical staging: confined to cervix/uterus, 3-5mm in depth
IA2
cervical staging: confined to cervix, uterus, >5mm in depth and <2cm in dimension
IB1
cervical staging: confined to cervix/uterus, 2-4cm in dimension
IB2
cervical staging: confined to cervix/uterus, >4cm in dimension
IB3
cervical staging: involvement of upper 2/3 vagina, <4cm
IIA1
cervical staging: involvement of upper 2/3 vagina, >4cm
IIA2
cervical staging: parametrial involvement
IIB
cervical staging: lower third of vagina involved
IIIA
cervical staging: extension to pelvic wall
IIIB
cervical staging: hydronephrosis
IIIB
cervical staging: pelvic lymph nodes
IIIC1
cervical staging: paraaortic lymph nodes
IIIC2
cervical staging: growth to mucosa of bladder or rectum
IVA
cervical staging: spread to distant organs
IVB
cervical ca: management for stage IA1
local excision
cervical ca: management of stage IA2-2A, <4cm
radical hysterectomy and lymphadnectomy
cervical ca: management of stage IA1-2A, >4cm
chemoradiation
cervical ca: management of stage IIB-IVA
chemoradiation
cervical ca: management of stage IVB
combined chemotherapy
vulval ca: 5y survival if no nodes involved
> 80%
vulval ca: 5y survival if inguinal nodes involved
<50%
vulval ca: 5y survival if iliac or other pelvic nodes involved
10-15%
vulval staging: confined to vulva, <2cm in size and <1mm deep
IA
vulval staging: confined to vulva, >2cm in size or >1mm deep
IB
vulval staging: extension to adjacant perineal structures
II
lower third of urethra, lower third of vagina, anus
vulval staging: 1 lymph node >5mm
IIIA
vulval staging: 1-2 lymph nodes <5mm
IIIA
vulval staging: 2+ lymph nodes >5mm
IIIB
vulval staging: 3+ lymph nodes <5mm
IIIB
vulval staging: positive nodes with extracupsular spread
IIIC
vulval staging: invasion of upper urethra, vaginal mucosa, bladder, rectum
IVA
vulval staging: fixed or ulcerated inguinofemoral nodes
IVA
vulval staging: distant mets, including pelvic nodes
IVB
1 year survival rates range, overall
72-89%
worst to best: ovarian, cervical, vulval, endometrial
5 year survival rates range, overall
42-75%
worst to best: ovarian, cervical, vulval, endometrial
going from 1 year to 5 year overall stats, whats the pattern
worst = -30,
worst ovarian at 1y becomes best endometrial at 5y
1 year - stage 1 survival range across all cancers
96-99
1 year - stage II survival range across all cancers
89-95
-10 from stage 1
1 year - stage III survival range across all cancers
73-83
-15 from stage 2
1 year - stage IV survival range across all cancers
43-54
-30 from stage 3
5 year - stage 1 survival range across all cancers
87-93
*highest = ovarian, lowest = cervical
5 year - stage II survival range across all cancers
67 and 74
ovarian = cervical
5 year - stage III survival range across all cancers
27 and 47
ovarian and endometrial only
5 year - stage IV survival range across all cancers
13 and 15
ovarian and endometrial only
