Gyne Flashcards
LN drainage for
- cervix
- endo
- vagina
- ovaries
- vulva
- parametrial, paracervical, obturator
- parametrial and obturator
- upper and middle obturator
- bilaterally along with ovarian blood vessels to PA nodes
- superficial inguinal–>deep femoral–>pelvis
Metastasis for
- cervix
- endo
- vagina
- ovaries
- vulva
- lungs, liver, bone
- lungs, liver, bone
- lung, liver
- liver, lung
- contralateral inguinal and pelvic LN
S&S
- cervix
- endo
- vagina
- ovaries
- vulva
- often found in screening. late stage presents with abnormal vaginal bleeding
(pelvic exam=staging) - Vaginal bleeding. 10-15% of all post-menopausal vaginal bleeding is cancer related
- asymptomatic–>abnormal vaginal bleeding (dysfunctional or post-coital)
- No specific signs or symptoms
-have to grow large before seeing S&S
-abdominal pain +/or pelvic pain - MC presenting location–>labia
pruritis
Epi/Eti
- cervix
- endo
- vagina
- ovaries
- vulva
- HPV(47)
- 4th most common cancer diagnosed in women (58)
cumulative unopposed estrogen exposure - Rare-HPV- history of VAIN
- 4-5th most common female cancer
age and family history
BRCA 1 40% risk
BRCA 2 18% risk - 3-5% of all gyne cancers
long history of local irritation
Prognostic indicators
- cervix
- endo
- vagina
- ovaries
- vulva
- nodal invasion
- stage
- stage and size
- tumour size and volume post-op
- size of lesion and depth of invasion
pathology
- cervix
- endo
- vagina
- ovaries
- vulva
- SCC
- Endometroid and adenocarcinoma
- Epithelial tumours
-SCC 65-85%
-Adeno 5-10% - Epithelial (90%)
subtype-serousa and stromal - SCC 90%
adeno 10%
Disease management Cervix
TAH +/- BSO- medically operable pts early stage
(IAI, IA2, IBI, IIA) followed by RT
Node positive or high risk will receive chemo (IIB or higher)
Typically combines EBRT + brachy (stage IB2/IIB)
Cervix dose
Brachy only: 45-50Gy HDR
T1N1M0 IBI
-EBRT 5040/28 pelvis
-HDR 2800/4
concurrent cisplatin (since positive node)
If nodes NOT positive T1N0M0, same disease may have TAH
-EBRT 4500/25 pelvic
-HDR 2800/4
NO chemo
Disease management for endometrium
Sx:
Stage IA Grade I or II= TAH alone
Stage III= sx + adj therapy
Stage IV= may or may not have TAH-BSO w/ other therapies
Chemo is always adj never alone for stage III & IV
RT is rarely used as a sole modality
post-op RT w/combo EBRT + HDR
Differences between Cervix and endometrium
- sx
- chemo
- RT
- dose for HDR
- Cervix: Stage IAI, IA2, IBI, IIA= TAH+/-BSO followed by RT
Endo: Stage IA or Grade I or II= TAH alone - Cervix: Node positive or stage IIB or higher
Endo: Stage III-IV - Cervix: combines EBRT + brachy
Stage IB2/IIB - Cervix 2800/4
endo: 2100/3
Endometrium Dose
Stage IA grade 1 or 2
-potential no RT post-op
Stage IA grade 3 or Stage IB grade 1 or 2
- post-op brachy
- dose given with HDR varies
- 2100/3fx
Stage IB G3, Stage II-IV
-EBRT + HDR 45-50.4Gy pelvis + brachy
Stage III+IV: RT primary
- low risk-brachy and EBRT
- high risk- pelvic, abdo EBRT and brachy and chemo
EBRT 50 HDR 21
- Vagina dose
2. Ovaries dose
- 70-85Gy EBRT + brachy
45GY EBRT - Abdominal dose of 2250/18 (125/fx)
Pelvic field boost: 45-50Gy
Vulva dose
50Gy for subclinical disease
boost 10-15Gy reduced fields
Pre-op RT:
-Chemo RT- 45-50Gy
Medically inoperable:
small superficial lesions; 60-65Gy RT alone
large tumours: primary RT reduced fields to 70Gy
boost; 6-9MeV or 4-6MV
Field borders Cervix
Sup: L5 Inf: bottom of obturator foramen Lat: 2cm past pelvic brim (4cm below disease) Ant: pubic symphasis post: includes S3/4
if PA nodes involved sup border goes to L2 or if PA nodes involved T12
Field borders Endometrium
Sup: L5
inf: upper 1/2 of vagina (bottom of obturator foramen)
lat: 2cm past pelvic brim (ext iliac nodes)
ant: pubic symphysis
Post: 2/3 of rectum S3