Gynecology Oncology Flashcards
List some of the sequelae with the treatment of gynecological cancers
- loss of fertility
- induction of menopause
- chemotherapy side effects
- cognitive impact
- radiotherapy leading to fibrosis and cystitis
Discuss the differential for ovarian masses
Functional (always benign) - corpus luteum cyst - follicular cyst - theca lutein cyst - hemorrhagic cyst Neoplasm - benign: dermoid cyst (most common) - malignant: epithelial (>40) and germ cell (<20) Other - PCOS - endometrioma - tubo-ovarian abscess - luteoma of pregnancy
List the differential for uterine mass
Symmetrical - pregnancy - adenomyosis - hematoma - endometrial cancer - impeforate hymen Asymmetrical - leiomyoma - leiomyosarcoma
Discuss the presentation of adnexal masses
Presentation
- most are asymptomatic
- mass effect leading to abdominal pain, urinary and GI symptoms
- chronic pelvic pain with dyspareunia and dysmenorrhea
- complications leading to torsion, rupture, hemorrhage or infection
- pelvic exam for size, consitency and mobility
- high Ca-125
Discuss the differences between benign and malignant masses
Exam - malignant are fixed, irregular and posterior - commonly bilateral Ultrasound Malignant - mixed, complex cyst - solid component that is nodular - no calcification - irregular shape and multilocular - thick seperation of >3mm - increased vascularity
Discuss the management of adnexal masses
- require surgical exploration and incision
Benign - conservative
- ovarian suppression with high estrogen OCP or GnRH agonist to suppress LH/FSH
- surgical for symptomatic, complications or infertility
Malignant - chemo, radio, and surgery depending on stage
List the risk factors for ovarian cancer
- older age
- Caucasian
- increased estrogen through nulliparity, delayed child bearing, early menarch or late menopause
- family history and BRCA1/2
- infertility
- PCOS
- endometriosis
- smoking
List the different types of ovarian cancer
Epithelial (70%) - serous which is most common which can be benign or malignant - mucinous - endometrioid Non-epithelial (30%) - germ cell - sex cord stream - metastatic
Pathophysiology
- loss of p53 leading to uncontrolled differentiation
Discuss the presentation and management of ovarian cancer
Presentation
- don’t usually present until >= stage 3
- non-specific symptoms
- abnormal uterine bleedin
- adnexal mass
Investigation
- CA-125 in post-menopausal women
- trans-vaginal ultrasound (>20mL in pre and >10 in post-menopausal)
Management
- stage 1 get surgery with possible adjuvant chemo
- stage >2 get neoadjuvant chemo then debulking and then adjuvant chemo with platinum plus taxane
Discuss the pathophysiology of follicular and corpus luteal cysts
Follicular
- follicle that failed to rupture during ovulation and is lined with granulosa cells
Corpus Luteal
- corpus luteum failed to regress after 14 days
- higher risk of rupture and bleeding
Discuss the management of adnexal cysts
- re-image in 6 weeks to see if regress with menstrual cycle
- OCP to prevent future cyst development
- surgery if symptomatic, suspicious, or large
- no surgery if corpus luteal as high risk of rupture and bleed
Discuss the presentation and management of a dermoid cyst
- contain all three cell lines
- have thick wall encapsulating skin, hair and teeth with thick sebaceous secretions leading to aseptic peritonitis
Presentation - abdominal and pelvic pain
- abnormal vaginal bleeding
- risk of torsion
Diagnosis - done by ultrasound where a unilocular, smooth walled, mobile cyst with calcification visualized
Management - surgery for >8cm or symptomatic
Differentiate between fibroids and endometrial cancer on ultrasound
Fibroids - hypoechoic - well encapsulated and circumscribed - clacification - cystic areas of necrosis or degeneration Endometrial Cancer - heterogeneity and irregular thickening - thickened endometrium >5mm - disruption of sub-endometrial halo suggesting myometrium invasion
Discuss the pathophysiology and pathology of endometrial cancer
Pathophysiology
- endometrial hyperplasia from high level estrogen unopposed by progesterone
Pathology
- Simple hyperplasia where normal glandular architecture with no atypia (1% risk)
- complex hyperplasia where complex, abnormal glandular architecture with no atypia (<5% risk)
- simple atypical hyperplsia have normal glandular architecture with cell atypia (10% risk)
- complex atypical hyperplasia have abnormal gland architecture and cell atypia (30% risk)
What are the different types of endometrial cancer and what are the risk factors for each
Type 1 - Endometrioid adenocarcinoma (from atypical endometrial hyperplasia) - obesity - diabetes - high estrogen states (similar to ovarian and breast) - PCOS - estrogen producing tumour - tamoxifen - Lynch syndrome Type 2 Serous clear cell carcinoma - tamoxifen
