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Women's Health Rotation > Neoplasms part 2 > Flashcards

Neoplasms part 2 Flashcards

1
Q

Type I endometrial CA

A

Caused by unopposed estrogen stimulation
Usually endometroid histology
Generally good prognosis- 90% cure stage I
About 70% diagnosed stage I

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2
Q

Type II endometrial CA

A

Unrelated to estrogen stimulation
Usually nonendometroid histology (clear cell, papillary serous)
Worse prognosis

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3
Q

RFs for endometrial CA

A

Obesity- extraovarian aromatization of androstenedione to estrone
Granulosa-theca cell ovarian tumors- about 15% have endometrial CA
Chronic anovulatory cycles (Stein-Leventhal syndrome)
Postmenopausal pts treated with unopposed ERT
Long-term tamoxifen
Alcohol intake: 2 or more drinks per day

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4
Q

Obesity and gynocologic CAs

A

BMI >35 is associated with increased mortality compared with nl wt in ovarian, cervical CA, and endometrial CA

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5
Q

What is the MC tx for endomtrial CA?

A

TAH with bilateral salpingo-oophorectomy

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6
Q

Endometrial carcinoma screening and prevention

A

In high risk pts- annual endometrial sampling and TVUS beginning at age 30-35
OCPs- possible chemoprevention
Risk-reducing hysterectomy for atypical endometrial hyperplasia

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7
Q

Endometrial adenocarcinoma

A

MC, typically postmenopause
Associated with excessive estrogen exposure
Often dx-ed with endometrial hyperplasia

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8
Q

Types of endometrial CA

A

Adenocarcinoma
Adenosquamous
Clear cell carcinoma
Serous carcinoma

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9
Q

Endometrial CA sx

A

Postmenopausal bleeding

Dysfunctional uterine bleeding (5% of endo CAs dx-ed

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10
Q

Name the types of endometrial hyperplasia from least risk of progression to CA to highest risk

A 
Simple hyperplasia without atypia
Complex hyperplasia without atypia
Simple atypical hyperplasia
Complex atypical hyperplasia
-These pts also have significant risk for concurrent endometrial adenocarcinoma
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11
Q

Genetic risk factors for endometrial CA

A

Lynch syndrome
Cowden syndrome
-Characteristic benign mucocutaneous hamartomas
-Uterine fibroids-40% of pts
-Increased endometrial, breast, thyroid, colorectal, and renal CAs

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12
Q

Screening and prevention of endometrial CA in pts with genetic RFs

A

Annual endometrial sampling and TVUS beginning at age 30-35
Risk-reducing hysterectomy
Oral contraceptives for possible chemoprevention

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13
Q

Endometrial CA workup

A

TVUS to evaluate endometrial lining

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14
Q

Endometrial CA: stage and spread at dx

A

Majority of uterine adenocarcinomas are dx-ed at early stage:

  • Confined to primary site (70%)
  • Spread to regional organs and lymph nodes (20%)
  • Distant metastases (10%)
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15
Q

Stage IA endometrial CA

A

Tumor confined to the endometrium

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16
Q

Stage IB endometrial CA

A

Invasion <1/2 myometrial thickness

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17
Q

Stage IC endometrial CA

A

Invasion >1/2 the myometrial thickness

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18
Q

Stage IIA endometrial CA

A

Endocervical glandular involvement only

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19
Q

Stage IIB endometrial CA

A

Cervical stromal invasion

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20
Q

Stage IIIA endometrial CA

A

Tumor invades serosa or adnexa, or malignant peritoneal cytology

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21
Q

Stage IIIB endometrial CA

A

Vaginal and/or parametrial metastasis

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22
Q

Stage IIIC1 endometrial CA

A

Metastasis to pelvic lymph nodes

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23
Q

Stage IIIC2 endometrial CA

A

Mets to P.A. nodes with or without pelvic lymph node metastasis

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24
Q

Stage IVA endometrial CA

A

Invasion of the bladder or bowel

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25
Q

Stage IVB endometrial CA

A

Distant metastasis, including intra-abdominal or inguinal LNs

26
Q

Tx of endometrial CA: surgical

A

Surgical tx includes: Peritoneal fluid cytology
Abdominal exploration
Pelvic and para-aortic lymphadenectomy
Abdominal hysterectomy and bilateral salpingo-oophorectomy

27
Q

Tx of endometrial CA: radiation and chemo

A 
Commonly added for more advanced stage and high-risk features
High-risk features include:
Pathologic grade 3
Serous or clear-cell tumors
Invasion of >1/2 the myometrium
Extension to the cervix or adnexa
28
Q

How are endometriosis and ovarian CA related?

A

They both involved the complement pathway
Current genetic testing research aims to separate women with benign endometriosis with endometriosis-associated ovarian CA

29
Q

Normal ovary size in premenopausal women

A

3.5 x 2 x 1.5 cm

30
Q

Nl ovary size in pt 2-5 yrs after menopause

A

1.5 x 0.7 x 0.5 cm

31
Q

What are u/s findings in ovaries that are suspicious for malignancy

A

Cystic mass vs solid
Smooth capsule vs excrescences
Presence of internal septa or papillae
Presence of ascites is very suspicious for malignant process

32
Q

Serum CA-125 and ovarian CA

A

Elevated in 80% of all pts with serous cystadenocarcinoma of the ovary but in only 50% of pts with stage I disease. Therefore not great for early dx and not for general screening.
Used for monitoring response to therapy

33
Q

Malignant adnexal lesions may be _____ or _______ dz from the uterus, breast, or gastrointestinal tract

A

Primary

Metastatic

34
Q

PE of adnexal neoplasm

A

Cervical, supraclavicular, and/or inguinal LAD and/or the presence of pleural effusions or ascites
Breast exam is especially important bc the ovary is a common site of metastasis from breast carcinoma

35
Q

Serum CA-125 in benign conditions

Normal value

A

Rarely greater than 100 to 200 U per mL

<35 U/mL

36
Q

Screening for ovarian CA

A

Do not screen women at average risk
Screen women at increased risk- women with familial ovarian CA syndromes, who have not undergone prophylactic oophorectomy
Screen with a combo of CA 125 and TVUS. Start at age 30 or 5-10 years earlier than the earliest age of 1st dx of ovarian CA in the family
Screen every six months.

37
Q

Human epididymis protein 4

A

An antigen derived from human epididymis protein, a product of the WFDC2 gene that is overexpressed in pts with serous and endometrioid ovarian carcinoma
Used to monitor recurrent or progressive dz in pts with EOC

38
Q

Lab reference range for human epididymis protein 4

A

Less than or equal to 150 pM

39
Q

Types of epithelial ovarian CA from most common to least common

A 
High-grade serous CA 
Endometrioid CA
Clear cell CA
Mucinous CA
Low-grade serous CA
40
Q

Epithelial ovarian carcinoma

A

CAs thought to arise from ovaries, but current thought is many of these CAs arise from Fallopian tubes or from Mullerian epithelium

41
Q

Prevention of ovarian Ca in women with familial CA syndromes and genetic predispositions for ovarian CA

A

These women may have risk-reducing surgery-BSO or hysterectomy and BSO

42
Q

Genetic mutations with increased risk of ovarian CA and other CAs

A

BRCA 1 and 2 gene mutations

Lynch syndrome

43
Q

What is the risk for developing ovarian CA related to?

A

Cause is unknown
Risk is related to parity
The more children a woman has and the earlier in life she gives birth, the lower her risk of ovarian CA

44
Q

Sx of ovarian CA- general

A

Often vague and non-specific
Women and their doctors often blame the sx on other, more common conditions.
Has usually spread beyond the ovaries by the time CA is dx-ed

45
Q

Sx of ovarian CA- specific

A 
Sense of pelvic heaviness
Vague lower abdominal discomfort
Vaginal bleeding
Wt gain or loss
Abnl menstrual cycles
Unexplained back pain that worsens over time
Increased abdominal girth
Non-specific GI sx
46
Q

Carcinosarcoma ovarian CA

A

Mean age dx 75 years

Histology is mixture of malignant epithelial and stromal tissues

47
Q

Borderline/LMP ovarian CA

A

Termed semimalignant, good prognosis
Surgery without chemo is current tx
Age at dx tends to be around 10 yrs younger than the other epithelial ovarian CAs
Serous and mucinous (serous more common) subtypes
CA-125 not helpful in dx or f/u

48
Q

Sex cord stromal tumors-ovarian CA

A 
Composed of 
Granulosa cells
Theca cells
Sertoli cells
Leydig cells
Fibroblasts of stromal origin, single cell type or in various combinations
CA-125 not useful in dx or f/u
Chemo tx usually bleomycin, etoposide, and cisplatin
49
Q

Granulosa-theca cell tumor

A

Often hormonally active and can produce large amounts of estrogen: pt may initially present with bleeding from endometrial hyperplasia

50
Q

Cause of 1/3 of pts with Sertoli-Leydig tumors

A 
Virilized from androgens and androgen precursors, causing:
Oligomenorrhea
Amenorrhea
Breast atrophy
Hirsutism
Deepening voice
Male pattern baldness
Acne
Clitoral enlargement
51
Q

What are the most common malignant ovarian tumors in young women?

A

Dysgerminoma and immature teratoma

52
Q

Tumor markers for ovarian CA germ cell tumor

A

LDH (best)
HCG
AFP

53
Q

S/sx of ovarian germ cell tumor
Prognosis
Tx

A

Tend to occur in young women and girls: swelling, possible abd pain
Curable if dx-ed and treated early
Tx is surgery then chemo

54
Q

Tx of ovarian CA

A

Surgical tx may be sufficient for malignant tumors that are well-differentiated (grade 1) and confined to the unruptured ovary (stage 1)
Addition of chemo is required for more aggressive tumors (grade 2 or 3) that are confined to the ovary
Pts with advanced disease (stage 2, 3, 4) standard of care is maximal cytoreductive surgery combined with multiagent chemo. Current favored regimen is carboplatin, Taxol, and Avastin

55
Q

Stage I ovarian CA

A

Limited to one or both ovaries

56
Q

Stage IA ovarian CA

A

Involves one ovary
Capsule intact
No tumor on ovarian surface
No malignant cells in ascites or peritoneal washings

57
Q

Stage IB ovarian CA

A

Involves both ovaries
Capsule intact
No tumor on ovarian surface
Negative washings

58
Q

Stage IC ovarian CA

A

Tumor limited to ovaries with any of the following: capsule ruptured, tumor on ovarian surface, positive washings

59
Q

Stage II ovarian CA

A

Pelvic extension or implants

60
Q

Stage IIA ovarian CA

A

Extension or implants onto uterus or fallopian tube

Negative washings

61
Q

Stage IIB ovarian CA

A

Extension or impolants onto other pelvic structures

Negative washings

62
Q

Stage IIC ovarian CA

A

Pelvic extension or implants with positive peritoneal washings

Women's Health Rotation (15 decks)

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