Ovary and Uterine Cancer (Tieman)

Question 1

most common genital tract malignancy in the US

Answer 1

carcinoma of the uterus

Most common clinical presentation is abnormal vaginal bleeding in perimenopausal or postmenopausal woman

Question 2

risk factors for carcinoma of uterus

Answer 2

Obesity
Unopposed estrogen stimulation (esp. 				postmenopausal)
Tamoxifen 
Nulliparity
Diabetes 
Late menopause
Polycystic ovary syndrome
Lynch syndrome

Question 3

what decreases risk for getting carcinoma of uterus

Answer 3

Ovulation
Progestin therapy
Combination BCP’s
Early menopause
Multiparity

Question 4

what 4 tests can you do first for evaluation of abnormal vaginal bleeding

Answer 4

Pelvic exam/Pap smear

Endometrial samping

Transvaginal ultrasound

Fractional D&C

Question 5

how is a uterine carcinoma staged

Answer 5

surgery

Question 6

Stage 1 uterine carcinoma

1a
1 b
1c

Answer 6

confined to uterine corpus

1a—confined to endometrium
1b—invasion to < ½ of myometrium
1c—invasion to > ½ of myometrium

Question 7

stage 2 uterine carcinoma

Answer 7

invaded endocervix or cervix

Question 8

stage 3 uterine

Answer 8

tumor in peritoneum, vagina or lymph nodes

Question 9

stage 4 uterine

Answer 9

distant mets, invasion of bladder or bowel mucosa, inguinal lymph node involvement

Question 10

what affects the prognosis of a carcinoma

Answer 10

grade and histology

Question 11

grade 1 5 year survival (endometrum)

Answer 11

95%

Question 12

grade 2 5 year survival endometrial

Answer 12

85%

Question 13

grade 3 endometrial carcinoma 5 yr survival

Answer 13

70%

Question 14

what type of endometrial carcinomas have favorable histology? what type have unfavorable ?

Answer 14

80% are favorable histology (Endometroid)
20% are unfavorable
Papillary serous carcinoma
Clear-cell carcinoma
Squamous cell carcinoma
Poorly differentiated carcinoma

Question 15

Stage 1a and 1b,Grades I and II, favorable histology can be treated with what

Answer 15

TAH-BSO, peritoneal washings and removal of any enlarged lymph nodes

Question 16

Grade 3 or unfavorable histology, stage 1c or stage 2 tumors require what treatment

Answer 16

TAH-BSO, cytology, and iliac/para-aortic node dissection +/- radiation

Question 17

stage 3 and 4 endometrial cancer treatment

Answer 17

Stages 3 & 4 require surgical debulking + radiation + chemotherapy

Question 18

stage 1 a endometiral and 1 b 5 year survival

Answer 18

90%

Question 19

stage 1 c uterine 5 year survival

Answer 19

80%

Question 20

stage 2 uterine surival 5 years

Answer 20

70-80%

Question 21

stage 3 endometrial 5 year survival

Answer 21

30-60%

Question 22

stage 4 endometrial 5 year

Answer 22

15%

Question 23

second most common but number 1 most lethal cancer of female genital tract

Answer 23

ovarian cancer

Question 24

increased risk for ovarian cancer>?

Answer 24

White race/USA
Nulliparity/infertility
Late childbearing
Late menopause
Family history
BRCA genetic mutation

Question 25

decreased risk factors for developing ovarian cancer?

Answer 25

``` Oral contraceptives Multiparity Breast feeding Tubal ligation hysterectomy ```

Question 26

which type of ovarian cancers produce elevated LDH

Answer 26

germ cell tumors

Question 27

stage 1 ovarian cancer

Answer 27

tumor confined to ovaries 1 c = cytology

Question 28

stage 2 ovarian

Answer 28

tumor spread confined to pelvis (2c=+cytology)

Question 29

stage 3 ovarian

Answer 29

Stage 3—tumor spread confined to abdominal peritoneal surfaces or retroperitoneal lymph nodes

Question 30

stage 4 ovarian cancer

Answer 30

distant mets

Question 31

what is the most important aspect for long term prognosis

Answer 31

Excision of any visible tumor Most important aspect for long term prognosis Bowel prep mandatory

Question 32

after excision of stage 1 low grade epithelial tumor what is done next

Answer 32

no further treatment

Question 33

stage 1 high grade epithelial tumor and beyond... after excision what is done

Answer 33

platinum-based chemotherapy +/- paclitaxel

Question 34

after gonadal stromal tumor is excised can you use chemo?

Answer 34

no relatively chemoresistant

Question 35

stage 1 stage 2 stage 3-4 5 year survival for epithelial cell tumors

Answer 35

Epithelial cell tumors Stage 1—75-95% 5-year survival Stage 2—65% Stages 3 and 4—20%

Question 36

germ cell tumors | stage 1, 2, 3 five year survival

Answer 36

Stage 1—95% Stage 2—80% Stage 3—60-70%

Question 37

stage 1 gonadal stromal 5 year survival

Answer 37

90%

Question 38

why do a fractional D and C

Answer 38

b/c of staging purposes send the endocervical curette separate from the corpus samples if its in the endocervical canal its stage 2