Gynec Onco Flashcards
Mc symptoms in ca cervix
Bleeding
Ca cervix eith hydroneph
3B
Ca cervix with prametrial inv
2 b
Lesion inv upper third epithelium
Cin 3
Mc abn Pap test result
Ascus 2-9%
Ascus best mgt
Hpv dna test
Alts trial
Adenoca instiu cin express ihc? Tsg?
P16 30-60%
Fertility sparing sx not done when
Gastric type adenoca
Small cell neuroendocrine
Adenoma malignum
Fertility sparing prefered for
Less than 2 cm
Upto 1B2
How much neg margin cone excision in fertility sparing
3 mm
Preferred method of cone biopsy in malignancy
Cold knife conization
Leep in hsil
Treatment for 1B3
Chemorad
2A1
Surgery
Modified rad hysterectomy
1a1 with lvi
and 1a2
Microinvasive ca
Less tha 5 mm depth
Largest extension les than 7mm
• When to do revision surgery after incidental finding in simple hysterectomy sAwithvs @ l3 with negative margins © 3 with positive margins a Gross residual disease
None
Sedlis criteria
Lvsi Strimal invasion Tr size Criteria for extrenal pevic rad after radical hysterectomy in Node neg Margin neg Parametria neg
Adenoma malignum aw which syndrome
Peutz jeghers
Ca cervix figo
Pelvic ln + is
3C
Figo staging
Read
Lnd which stage onwards in ca cervix
Ia1 eith lvi or 1a2
Hsil treatment
Leep
Cin 2 is div into lsil and hsil based on
P16
Infants squamocolumnar junction at mcly in cervix
Ectocervix
Nueroendocarcinoma of cevix most sensitive marker
Most specific
Sensitive CD56 Synaptophysin
Specific Chromogranin
Colposcopy
Sharp border inner border sohn ridge sign seen in
Grade 2 major
Staging of ca cervix
Pet ct or pet mri in
Nore than or eq 1B1
Reid index
Marhin
Colour
Vessels
Iodine staining
Swede index
Aceto uptake Margins or surface Vessels Lesion size Iodine staining
Types of hysterectomy
Querlow and morrow
© Type A: Minimum Resection of Paracervix This
is an extrafascial hysterectomy.
© Type B: Transection of the Paracervix at the
Ureter This type has two levels:
B1-Without removal of lateral paracervical
lymph nodes
© B2-With removal of lateral paracervical
nodes
At least 10 mm of the vagina from the cervix
or tumor is resected.
• Type C In type C, the paracervix is transected
at the junction with the internal iliac
vascular system and has two types:
© C1-With nerve preservation
C2-Without preservation of autonomic
nerves
The ureter is mobilized completely, and 15
to 20 mm of vagina from the tumor or cervix
and the corresponding paracolpos is resected
routinely
© Type D In type D, the entire paracervix is
resected:
• D1-Resection of the entire paracervix along
with the hypogastric vessels
• D2-Resection of the entire paracervix, along
with the hypogastric vessels and adjacent
fascial or muscular structure
Radical hysterectomy tyoe
C1
Modified is b
Radiation dose in cervic ca
80Gy
Slnb in ca cervix when size less than
2cm
Gardasil 9 includes
31
45
48
52
Earliest abn in ca cervix
Blurring of stromoepithelilanjunctiok with protrusion of cells into stoma
Senticol trial
Sentinel lnb in ca cervix
Lilacs
Lnd in lacacervix
Chemo in ca cervix
Cisplatin
If not then carbo
Chemo in ne cervic ca
Cisplatin etoposide
Carbo
Tests for mets or recurrent ca cervix
MSI
NTRK
PDL1
How many ca endometrium before menopause
20%
Msi mc in ca endometrium
Mlh1> msh6
Mc histology in ca endometrium
Endometrioid
Abn thicknes of endometrium
5 mm
Use of ca125 in endometrial ca
Use of CA 125 in endometrial cancer A • Pelvic node mets © Para aortic node mets © Predicting treatment response © Surveillance © Extra uterine disease
Most aggressive histology in ca endo
Serous aka uterine ppilalry serous cancer
Mskcc prognostic factors in nomogram for ca endometrium
Age at dx Neg ln Stage grade Histology
Type 1 endo ca
> Type 1 with hyper oestrogenism like anovulatory bleeding, infertility, late menopause and endometrium hyperplasia. © Good prognosis © Well differentiated • Less invasion © PI3K/AKT
Type 2 endo ca
• Type 2 lack hyperoestrogenism , older © Poorly differentiated © Extrauterine spread © P53 p16 © In addition to TP53 mutations, type II endometrial cancers are characterized by HER2/neu amplification, loss of ER/PR, and loss of E-cadherin.
Future 1 and 2 trials
Guardasil
Patricia and costarica hpv trial
Cervarix
Complex hyperplasia with atypia risk of endo ca
30%
Endometrial ca in atypical hyperplasia hysterectomy sample
42%
Mc cause of death in ca cervix
Uremia
High intermediate risk ca endo
NIf HIR per GOG 249: age 50-69 y with two risk factors or age <50 y with three ris
factors, or age 270 y with one risk factor. Risk factors include grade 2 or 3, deptr
of invasion to outer half, and LÜSI.
Radical hysterectomy from which stage in ca endo
2
Portec trial
Endometrium ca
Endomteroid ca gentic clases 4
Molecular markers
Mc and excellent prognosis -pole hyper mutation High copy number worst prognosis Copy number low beta catenin mutation Msi hyper mutation Markers- her2 ntrk erpr
Endo ca clear cell type 4 molecular types
Pole
Mismatch repair deficient
Copy number high and low
Ca endo metrium slnb
Done when limited to uterus without mets
Injected into cervix
Mc involves ventral to hypogastric
Medial to ext ilic and superior to obturator
Er staging done when in ca endo
Stage 3,4 recurrent
Her2 in ca endo tested when
Recurrnt
Serous
Paraortic surgical stagin in endo ca
Advanced stage High grade Clear cell Serous And carcinosarcoma
Fertilitpreservation in ca endometrium
Wd endometrioid G1 Linited to endometrium No mets no nodes No ci to medica tt or pregnancy Continous progestin based for 6 m to 1 yr- megestrol medroxyprog levonorgestrel iud
Mc site of neuroendocrine ca in female GUT
Cervix
G1 in endoca how much solid sheets
Endometrioid <5% solid sheets g1
G2- adeno ca 6-50%
G3- >50%
Mixed mullerian tr
Carcinosarcoma
Riskfactor
Radiation and tamoxifen
Mc sarcoma in endo
Lms
Higrsde endometrstromal sarcoma fusion?
YEHAE NUTM 2A/B
Node postivity in lms ess
3C
Hormonal therapy in uterine sarcoma for
Low grade ess
And receptor postive lms
Lms in uterine markers
Sma
Desmin
Plag1 + inmyxoid
Hmb45 and melan A neg
Low garde ess positve markers
Jazf1 suz12
Er pr
Cd10
Drug for sarcoma uterine
Doxo
Endo carcin ct
Paclicarbo
