gynecologic neoplasms Flashcards
1
Q
What are the epidemiological trends for cervical cancer?
A
Third most common gynecological malignancy in the US after endometrial and ovarian cancer. Peak incidence at 35-44 years of age.
2
Q
What is the primary cause of cervical cancer?
A
Infection with HPV, primarily types 16 and 18.
3
Q
What percentage of anal, vaginal, and vulvar cancers are caused by HPV?
A
HPV causes approximately 90 percent of anal cancers, 70 percent of vaginal cancers, and 40 percent of vulvar cancers.
4
Q
At what age is the prevalence of genital HPV highest?
A
Prevalence is highest in those aged 20 to 24 years (45 percent).
5
Q
What is cervical intraepithelial neoplasia (CIN)?
A
A noninvasive precursor lesion that may develop from an HPV infection over months to years, potentially progressing to invasive carcinoma.
6
Q
What are the early symptoms of cervical cancer?
A
- Abnormal vaginal bleeding * Abnormal vaginal discharge * Dyspareunia * Pelvic pain
7
Q
What is the significance of the Papanicolaou (Pap) test?
A
Reduced the incidence of and mortality from invasive cervical cancer by more than 80 percent in the U.S.
8
Q
What are the types of devices used for cervical sampling?
A
- Cytobrush * Spatula * Broom
9
Q
What are the common treatments for pre-invasive lesions (CIN1-3)?
A
- Cryotherapy * LEEP * Cautery * Cone biopsy
10
Q
What are the two main types of endometrial cancer?
A
- Type I (80% of cases) * Type II (20% of cases)
11
Q
What is a significant risk factor for uterine (endometrial) cancer?
A
Increased estrogen stimulation leading to excessive proliferation of the endometrium.
12
Q
What are the protective factors against endometrial cancer?
A
- Low estrogen and high progestin levels * Multiparity * Combination oral contraceptive pills * Regular physical exercise * Lifelong soy-rich diet
13
Q
What are the clinical features of localized endometrial cancer?
A
- Abnormal uterine bleeding (AUB) * Postmenopausal bleeding * Intermenstrual bleeding in premenopausal women
14
Q
What is the initial diagnostic approach for suspected endometrial cancer?
A
- CBC * Coagulation studies * Pregnancy test * Endometrial biopsy with histology * Transvaginal US
15
Q
What is the most common subtype of endometrial carcinoma?
A
Endometrioid carcinoma (Type I).
16
Q
What is the staging system for uterine cancer?
A
- Stage I: carcinoma confined to the corpus * Stage II: carcinoma involving the cervix * Stage III: carcinoma that has spread outside the uterus but confined to the pelvis * Stage IV: carcinoma that has extended outside the true pelvis
17
Q
True or False: HPV vaccination is a form of primary prevention for cervical cancer.
A
True
18
Q
Fill in the blank: The peak incidence of cervical cancer occurs at ages _______.
A
35-44 years
19
Q
What is the most common cause of death due to a gynecological malignancy?
A
Cervical cancer ranks as the third most common cause of death due to a gynecological malignancy.
20
Q
What is the clinical significance of HPV types 16 and 18?
A
HPV 16 is more commonly associated with squamous cell carcinoma of the cervix; HPV 18 is associated more with adenocarcinoma.
21
Q
What is the prevalence of HPV infection among sexually active individuals soon after the initiation of sexual activity?
A
Common soon after sexual activity initiation.
22
Q
What is the typical age range for the peak incidence of endometrial cancer?
A
55-64 years
23
Q
What are some common environmental risk factors for cervical cancer?
A
- Cigarette smoking * Exposure to second-hand smoke
24
Q
What is the purpose of a colposcopy?
A
To evaluate the cervix after an abnormal Pap smear.
25
What is the most important prognostic determinant for uterine cancer?
Staging and prognosis are based on surgical and pathologic evaluation only.
26
What defines Stage I carcinoma in uterine cancer?
Carcinoma confined to the corpus.
27
What defines Stage II carcinoma in uterine cancer?
Carcinoma involving the cervix.
28
What defines Stage III carcinoma in uterine cancer?
Carcinoma that has spread outside the uterus but is confined to the pelvis.
29
What defines Stage IV carcinoma in uterine cancer?
Carcinoma that has extended outside the true pelvis +/- bladder or rectum.
30
How does tumor grade affect prognosis in uterine cancer?
Well-differentiated tumors (Grade I) have a better prognosis than poorly differentiated ones.
31
What is the recommended treatment for postmenopausal patients with disease confined to the endometrium and myometrium?
Total hysterectomy and bilateral salpingo-oophorectomy.
32
What treatment options exist for patients wishing to preserve fertility in early-stage endometrial carcinoma?
Possible uterine preservation and progestins.
33
What is the prognosis for localized endometrial carcinoma?
> 90% 5-year survival rate.
34
What is the prognosis for metastasized endometrial cancer?
< 20% 5-year survival rate.
35
Which types of endometrial carcinomas have a more favorable prognosis?
Well-differentiated carcinomas with estrogen receptors (type I).
36
Which types of endometrial carcinomas have an aggressive course and poor prognosis?
Clear cell and papillary serous carcinomas (type II).
37
What routine actions can help prevent endometrial cancer?
Screen for and address risk factors, manage obesity, avoid unopposed estrogen, manage associated conditions, educate on smoking cessation.
38
Who should undergo yearly TVUS with aspiration biopsy from age 35?
Patients with Lynch syndrome who wish to preserve their uterus.
39
What is the most likely diagnosis for a 55-year-old woman with progressive abdominal bloating and a family history of cancer?
Ovarian Cancer.
40
What is the peak incidence age range for ovarian cancer?
55–64 years of age.
41
What are the genetic predispositions that increase the risk of ovarian cancer?
* BRCA1-positive: 25–65%
* BRCA2-positive: 10–30%
* MMR gene mutation: 10%.
42
What is the first-line diagnostic tool for evaluating suspected ovarian cancer?
Transvaginal ultrasound.
43
What tumor markers are associated with ovarian cancer?
* CA-125
* B-HCG
* AFP
* LDH
* Inhibin.
44
What is the management approach for progressive serous ovarian cancer?
Radical surgical staging.
45
What should be the next step for a 62-year-old postmenopausal woman with abnormal vaginal bleeding and an endometrial thickness of 9 mm?
Endometrial biopsy.
46
What is the most appropriate next step in management for a woman with HSIL on Pap smear?
Colposcopy with biopsy.
47
What is the most appropriate next step for a woman with a palpable, irregular adnexal mass and a complex ovarian mass on ultrasound?
Schedule surgical biopsy.
48
what subtypes of cervical cancer are secondary to HPV infection?
squamous cell and adenocarcinoma
49
how does HPV infect the cervix
infects the stem cells of the basal cell epithelium
migration of virus-infected daughter cells into the suprabasal cell layer allows the infection to spread
50
T or F: HPV is a ssRNA virus.
false
dsDNA w/ a capsid
51
HPV primarily affects what type of cervical cells
squamous or metaplastic epithelial cells
52
which region of the cervix is most suspectable to HPV infection?
transformation zone
53
unlike the low-risk serotypes, oncogenic serotypes have the ability to do what?
integrate their viral genome into human DNA leading to higher risks of cell abnormalities and cancer
54
what proteins to oncogenic HPV use to replicate inside the cervical cells?
E1 & E2
55
what on Pap tests indicates oncogenic HPV?
low-grade squamous intraepithelial lesions
56
HPV 16 is more commonly assoc. w/ what cervical cancer subtype?
squamous cell carcinoma
57
HPV 18 is more commonly assoc. w/ what cervical cancer subtype?
adenocarcinoma
58
what symptoms are assoc. w/ the later stages of HPV infection
hydronephrosis
lymphedema
fistula formation
59
T or F: colposcopy becomes necessary after an abnormal pap smear
true
60
describe the 4 stages of invasive cervical cancer.
0 - carcinoma in situ
I- confined to cervix
II - spread to vaginia
III - extend to pelvic wall
IV - extend beyond pelvis
61
name the precursor lesions to SCC of the cervix.
CIN or SIL
62
describe the cellular morphology of SSC of the cervix.
keratinizing or nonkeratinizing
prominent nucleoli
nonspherical nuclei
loss of basal membrane
63
name the precursor lesion for adenocarcinoma of the cervix
endocervical adenocarcinoma in situ
64
severe dysplasia and carcinoma in situ are categorized as what
CIN 3
65
T or F: HSIL is considered for CIN 2 & 3
true
66
how is CIN 1 categorized?
LSIL
w/ mild dysplasia
67
describe the process of cryotherapy
N2 gas flows through a probe to freeze and destroy the abnormal cervical tissues
68
describe the process of a cold cone biopsy.
a large area of tissue around the cervix is excised for examination
69
list primary preventions of cervical cancer.
HPV immunization
protective sex
70
what would be considered secondary prevention of cervical cancer
adherence and compliance to cervical cancer screening recommendations
71
what vaccine is recommended for all girls aged 9-26 yrs. of age
cervarix
coverage against HPV 16 & 18 serotypes
72
what vaccine is recommended for all boys and girls within the 9-26 age range?
gardasil-4
coverage against HPV serotypes: 6, 11, 16, 18
73
what endometrial cancer more commonly presents nearer to menopause?
Type I
74
T or F: cervical cancer is the most common cancer of the female genical tract.
false
most common is endometrial cancer
75
what uterine cancer type is more commonly assoc. w/ pts. who are 65+ yrs. old?
Type II
76
what are secondary causes of uterine cancers?
HRT w/o progestin
obesity
77
what are primary causes of uterine cancers?
lynch syndrome
PCOS
estrogen-producing ovarian tumors
tamoxifen
78
what are risk factors for uterine cancers?
nulliparity
early or late menopause
h/o breast cancer
tamoxifen
PCOS
lynch syndrome
79
list the systemic symptoms of metastatic uterine cancers.
weight loss
lethargy
cough
pleural effusion
80
pts. under the age of 45 can qualify for endometrial biopsy. list the qualifications
more than 1 of the following:
persistent AUB
exposure to unopposed estrogens
81
describe the histologic characteristics of endometrial hyperplasia w/o atypia
"Swiss cheese" pattern of enlarged, dilated mucous membrane glands in b/t abundant stromal tissue
very little endometrial proliferation
82
describe the histologic characteristics of endometrial hyperplasia w/ atypia
pronounced proliferation of glandular tissues w/ no separating stroma
cells are atypical w/ extensive mitosis and loss of cell polarity
83
T or F: there is no precursor lesion for Type II endometrial carcinoma
true
84
how are Type I & Type II endometrial carcinomas different
Type 1- estrogen dependent, usually grade 1 or 2, most common, good prognosis
Type 2- estrogen independent, grade 3, rare, poor prognosis
85
T or F: endometrial sarcomas arise from tumors in the myometrium.
false
arise De Novo (no assoc. w/ tumors)
86
how is leiomyosarcoma defined?
pure sarcomas differentiate toward myometrial smooth muscle
87
pure sarcomas that differentiate towards the endometrial stroma are referred to as what?
endometrial stromal tumors
88
Clear cell and papillary serous carcinomas are categorized under what endometrial cancer subtype?
Type II
89
T or F: endometrial cancer has the highest mortality rate of any gynecologic cancers in the US.
false
ovarian cancer wins the gold medal for highest mortality rate amongst different gynecological cancers
90
what are secondary risk factors for ovarian cancer?
lincreasing age
cigarette smoking
asbestos exposure
nulliparity
91
what are primary risk factors for ovarian cancer?
endometriosis
HRT
PCOS
BRCA gene mutations
HNPCC syndrome
92
what hormonal factors are protective against ovarian cancer?
oral contraceptives
breastfeeding
parity
pregnancy before age 26
93
composite a list of symptoms indicative of a gynecologic neoplasm in its early stages.
early satiety
abdominal distention or bloating
Pain in pelvic and abdominal regions
changes in urination
abnormal bleeding
94
composite a list of signs indicative of advance gynecologic neoplasm
ascites
pleural effusions
bowel obstruction
95
what are the most common types of ovarian tumors
epithelial
CA-125 +
96
list the ovarian germ cell subtypes of ovarian tumors.
extraembryonic
somatic
no differentiation
97
what is an example of an extraembryonic ovarian germ cell tumor?
yolk sac tumor
98
ovarian germ cell tumors w/ somatic differentiation are referred to as what?
teratomas
99
ovarian germ cell tumors w/o differentiation are referred to as what?
dysgerminomas
100
what ovarian tumor subtypes are estrogen producing?
granulosa and theca cell tumors
101
what chemotherapeutic agents are used for management of ovarian cancers?
carboplatin & taxane
102
make sure to review the following
practice questions at end of gynec.neopla. ppt
103
what sex cord and stomal ovarian tumors are benign?
ovarian fibromas
thecal cell tumors
sertoli Leydig tumors
104
what sex cord and stomal ovarian tumors are malignant?
granulosa cell tumors
105
what epithelial ovarian tumors are considered benign?
both serous and mucinous cystadenomas
brenner tumors
106
what epithelial ovarian tumors are malignant?
endometrial carcinoma
clear cell tumors
107
clear cell teratomas are assoc. w/ what?
dermoid cysts (clumps of skin)
strums ovarii (thyroid tissue in the ovaries)
