Gynecologic Cancers

Question 1

Endometrial Cancer

Risk Factors
obesity, nulliparity, late menopause, chronic anovulation, tamoxifen use, estrogen replacement therapy, diabetes, HTN, cancer of breast, ovary or colon, family history
1. What is the common uniting pathophysiology?

Most common symptom: abnormal vaginal and uterine bleeding

2. Dx standard of care?
3. Surgical Tx?
4. Medical tx?
5. Spread via what lymph nodes?

Answer 1

Endometrial Cancer

1. Pathophysiology: unopposed estrogen exposure
2. Dx via endometrial biopsy
   * if not possible, do D+C with hysteroscopy
3. Surgical Tx: TAH-BSO
4. Medical Tx: high dose progestins
   (eg, megestrol, medroxyprogesterone)
5. Spread via pelvic and para-aortic lymph nodes

Question 2

Ovarian Cancer

3 origins: epithelial, germ cell, sex cord-stromal

1. Most common etiology?
2. Most common type of germ cell tumor?

Answer 2

Ovarian Cancer

1. epithelial origin most common (serous cystadenocarcinoma)
2. dermoid cyst (aka, benign mature cystic teratoma)
   - -Note: 3 general types of germ cell tumors: teratoma, choriocarcinoma, endodermal sinus tumor (yolk sac)

Question 3

Ovarian Cancer: Germ Cell Tumors
–most common ovarian cancer in women acute presentation of pelvic pain, pressure symptoms on bladder/rectum, tumor rupture

Associated tumor marker?

1. dysgerminoma
2. endodermal sinus (yolk sac)
3. choriocarcinoma

Answer 3

Ovarian Cancer: Germ Cell Tumors

1. dysgerminoma: LDH
2. endodermal sinus tumor (yolk sac): AFP
3. choriocarcinoma: hCG

Question 4

ovarian tumor + ascites + right hydrothorax

Dx?

Answer 4

Meigs Syndrome

–ovarian tumor + ascites + right hydrothorax

Question 5

Ovarian Cancer: Sex Cord-Stromal Tumors
–3 types: granulosa-theca cell; Sertoli-Leydig; ovarian fibroma

1. Granulosa-theca cell tumor
   - -produce what hormone?
   - -histo: granulosa cells with coffe-bean nuclei; cells arranged in clusters around central cavity
2. Sertoli-Leydig tumors
   - -produce what hormone?

Answer 5

Ovarian Cancer: Sex Cord-Stromal Tumors

1. Granulosa-Theca Cell Tumor
   - -estrogen production –> feminization, menstrual irregularities, post-menopausal bleeding, endometrial hyperplasia (risk of endometrial cancer)
   - -Call-Exner bodies
2. Sertoli-Leydig tumors
   - -produce testosterone –> hirsutism, breast atrophy, deepened voice, acne, clitoromegaly, receding hairline, oligomenorrhea

Question 6

Vaginal Cancer
–3 most common s/s: vaginal pruritus, discharge, bleeding

1. Most common type?
   - -usually involves posterior wall and upper third of vagina
2. Type associated with DES exposure in utero?
   - -polypoid masses on anterior aspect

Answer 6

Vaginal Cancer
–vaginal pruritus, discharge, bleeding

1. Squamous cell carcinoma
   - -posterior wall, upper third of vagina
   - -can be associated with HPV infection, smoking
2. Clear cell adenocarcinoma
   - -DES exposure in utero
   - -polypoid masses on anterior aspect

Question 7

Vulvar Intraepithelial Neoplasia

• -often dx when pts treated for candidiasis don’t respond to antifungal creams
• -palpable abnormality, perineal or perianal burning, dysuria
• -need to biopsy

Risk factors:

1. cigarette smoking
2. immunodeficiency, immunosuppression
3. HPV – which two strains?

Answer 7

Risk factors for vulvar intraepithelial neoplasia:

1. cigarette smoking
2. immunodeficiency, immunocompromise
3. HPV 16, 18

Question 8

Vulvar Cancer

–method of spread?

Answer 8

Vulvar Cancer
–spread via inguinal LNs

NB: SCC – most common vulvar malignancy
–may appear ulcerated

Question 9

Cancer of the Vagina and Cervix

1. Squamous cell carcinoma
   - -two main risk factors?
2. Clear cell adenocarcinoma
   - -main risk factor?

Answer 9

Cancer of the Vagina and Cervix

1. SCC
   - -HPV, cigarette smoking
2. Clear cell adenocarcinoma
   - -DES exposure in utero