Malignancy of genital tract Flashcards
What is the most common cause of death in cervical cancer?
renal failure
What are the signs and symptoms of cervical cancer?
- Asymptomatic in the early stages (hence the need for screening)
- Vaginal bleeding - most common clinical finding. Can be intermenstrual or postcoital
- Foul smelling (blood-tinged) vaginal discharge
- Dyspareunia
- Pelvic pain
note: dyspareunia + pelvic pain can be a sign of advanced cervical CA
What are the risk factors of cervical cancer? (10)
- immunocompromised state (infection -> cancer)
- Genetics
- Iatrogenic
- Early coitarche
- Multiple partners (more than 6)
- HPV infection
- History of STI
- OCP use
- History of vulvar/vaginal dysplasia
10/ Smoking - squamous cell carcinoma
How is cervical cancer screened and diagnosed?
Give five characteristics of ATYPIA
Give other findings of abnormal cells
- Screening is pap smear at 21 years old or 3 years after the beginning sexual activity not less than 21 years old.
- this is via conventional cytology or liquid-based cytology
- Visual inspection with acetic acid (abnormal tissue becomes white)
- Visual inspection with Lugol’s iodine - there are scattered non-iodine uptake areas if neoplasia
- Co-testing (same time HPV DNA test with cytology) and Reflex testing (Cytology then DNA)
- Definitive diagnosis is COLPOSCOPY GUIDED BIOPSY
- increased N:C ratio
- hyperchromasia
- perinuclear halo
- nuclear irregularity
- chromatin clumping
- Koilocytosis - perinuclear cavitation, from HPV infected keratinocytes
What are the prognostic factors in cervical cancer?
- Tumor size
- FIGO stage (most important determinant)
- Nodal involvement
- Lymph vascular space involvement
- Histologic type (adenocarcinoma has poorer prognosis)
What is the treatment for cervical cancer?
When is follow up?
What are the 3 types of cervical cancer? what are some traits?
- Concurrent chemoradiation is the mainstay treatment with CISPLATIN as the agent (nephrotoxic, make sure renal function is there)
- Surgery, cone biopsy or radical trachelectomy (removal of cervix, upper vagina, and parametrium)
- If patient cannot receive chemo, radiation alone may be given: external beam radiotherapy (teletherapy)
- Internal beam radiotherapy: brachytherapy - weekly during therapy
- 2 weeks after completion
- then 3 months for the first 2 years, every 6 months for the second 3-5 years, annually thereafter.
- Squamous cell carcinoma - most common type
- Adenocarcinoma - more recurrent, poorer prognosis, but same pattern and spread
- Mixed, adenosquamous
Which HPV types cause cervical cancer and which cause condyloma acuminata?
High risk = 16 and 18 (cervical cancer)
Low risk = 6 and 11 (condyloma acuminata)
What is the normal thickness of the endometrium at the proliferative phase and secretory phase?
- proliferative phase = 1-2mm
2. secretory phase = 8-14mm
What are the four types of endometrial hyperplasia?
How do you diagnose endometrial hyperplasia?
Symptoms?
Treatment?
- Simple hyperplasia without atypia - increased dilated glands
- Complex hyperplasia without atypia - glands are crowded with scant stroma between them
- Simple hyperplasia with atypia
- complex hyperplasia without atypia - glands are irregularly shaped and are crowded. Nucleus shows atypia (increased N:C, perinuclear halo, chromatin clumping)
- Transvaginal ultrasound, for premenopausal women <15mm, for postmenopausal women <5mm.
- Endometrial sampling and D&C
- Intermenstrual or irregular bleeding for premenopausal women
- any vaginal bleeding in post menopausal women
- for simple and complex without atypia, MPA 10-20mg OD for 14 days, after 3 mos reasses then if endometrium is normal, MPA 5mg/10days/month for 12 months. IF PERSISTENT, 40mg OD for 3 months
- EHBSO if no desire for uterine preservation
3.If simple or complex WITH atypia, MPA 10-20mg OD for 3 mos, if persistent 3 mos MPA 40mg, if still persistent EHBSO
What is the most common malignancy in the genital tract?
Where is it more common in women of what menopausal status?
What are the two types?
Endometrial carcinoma
Perimenopausal and postmenopausal
- Type I = Endometrial CA
- Type II = serious papillary
What are signs and symptoms of endometrial carcinoma?
- AUB (most common symptom)
- Enlarged uterus
- Stigmata of chronic anovulation such as hirsutism, acanthosis and acne
What are risk factors for endometrial carcinoma?
What is the route of spread?
What is the gold standard of diagnosis?
What is the degree of differentiation?
Management?
- Unopposed estrogen stimulation, or exogenous estrogen without progesterone
- Unopposed menopausal estrogen replacement therapy
- Late menopause after 52 years
- Early menarche
- Obesity (x10 increased risk)
- Diabetes
- Nulliparity
- PCOS or chronic anovulation
- Tamoxifen (usually for breast cancer) because it is inhibitory to the breast but stimulatory to the endometrium
- pelvic and paraaortic node drainage sites
- Hysteroscopic guided biopsy
- G1 = <6%, well differentiated
- G2 6-50% moderately differentiated
- G3 >50% of solid compartments = poorly differentiated
- TAHBSO, node sampling, peritoneal washing
- Adjuvant therapy can include radiation; hormone treatment
- Advanced or Recurrent: Chemotherapy with high-dose progestin
Just read Ovarian CA in the transes