Gynecologic Oncology Flashcards
First line chemo in uterine cancer
Carboplatin + paclitaxel (+trastuzumab in HER2 positive serous carcinoma)
What non-chemotherapy regimen may be superior to tamoxifen/megace in endometrial cancer?
everolimus/letrozole
What defines high-risk early stage ovarian cancer?
Stage IC or II; clear cell histology (any stage); Grade 3 tumors (any histology)
Which gene is thought to play a role in small-cell carcinoma hypercalemia-type ovarian cancer?
SMARCA4 (occ SMARCA2 as well)
How are Stage IA, IB, and IC ovarian cancer defined?
IA = Tumor limited to one ovary with capsule intact; IB = Tumor involves both ovaries, but capsules are intact; IC = tumor involves one or both ovaries with either surgical spill, capsule ruptured before surgery or tumor on ovarian or fallopain tube surface, or malignant cells in ascites or peritoneal washing
How is platinum sensitive vs. insensitive defined in ovarian cancer?
Recurrence in less than or greater than 6 months
What are genetic changes characteristic of Type 1 endometrial cancer?
K-Ras, PTEN, beta-catenin mutations
What are genetic changes characteristic of Type 2 endometrial cancer?
p53, HER2 amplificaiton, Bcl2 amplification
What is chemotherapy choice for platinum-resistant ovarian cancer?
Doxil + bevacizumab
How are borderline ovarian tumors (tumors of low malignant potential) defined?
Epithelial proliferation with absence of stromal invasion
What stages of dysgerminoma is chemotherapy recommended?
Stages II-IV
What stages of granulosa cell tumors should receive chemotherapy?
Stage IC-IV (Carbo/taxol or BEP)
Which type of endometrial cancer is estrogen dependant?
Type 1
What is stage IA ovarian cancer?
cancer only within one ovary and no cancer on surface
What is stage IB ovarian cancer?
Cancer in both ovaries, but no cancer on the surface
What is stage IC ovarian cancer?
Cancer in on or both ovaries, plus cancer has spread to surface of one or both ovaries or cancer cells are in abdominal fluid
What is stage II ovarian cancer?
Cancer has spread to nearby organs in the pelvis
What is stage III ovarian cancer?
Cancer has spread to the peritoneum
What is stage IV ovarian cancer?
Cancer has spread outside the pelvis and peritoneum
When can you observe ovarian cancer after surgery?
IA or IB if grade 2 endometroid (NOT high grade serous or grade 3 endometrois)
What is stage IA endometrial cancer?
Less than half myometrial invasion
What is stage IB endometrial cancer?
More than half myometrial invasion but does not extend past the uterus
What is stage II endometrial cancer?
Invades cervical stroma
Adjuvant treatment for Stage I endometrial cancer?
Observation for G1/G2 stage IA. RT +/- systemic therapy for IB G3. Otherwise vaginal bracytherapy.
Adjuvant treatment for Stage II endometrial cancer?
EBRT and/or vaginal brachytherapy +/- systemic therapy
Adjuvant treatment for Stage III/IV endometrial cancer?
Systemic therapy +/- EBRT +/- vaginal brachytherapy
What is stage IIIA endometrial cancer?
Tumor invades the serosa of the uterus and/or adnexae
What is Stage IIIB endometrial cancer?
Vaginal and/or parametrial involvement
What is Stage IIIC endometrial cancer?
Metastases to pelvic and/or para-aortic lymph nodes
What are risk factors of uterine carcinosarcomas?
Similar to type 1- unopposed estrogen exposure
What treatment is recommended to women with resected uterine carcinosarcoma?
Ifosfamide, msna, and cisplatin
What is the treatment for low-risk gestational trophoblastic neoplasia?
Single agent methotrexate or dactinomcyin
What is the treatment for high-risk gestational trophoblastic neoplasia?
Combination chemotherapy with methotrexate and etoposide and actinomycin alternating with cyclophosophamide and vincristine
What is the criteria for high-risk gestational trophoblastic neoplasia?
hcg >40,000, non-pulmonary visceral metastases, and >4 months to the diagnosis of malignant transformation
When is chemotherapy not required for ovarian germ cell tumors?
Stage 1 dysgerminomas, or grade 1, stage IA immature teratomas
