Reproductive System Cancers Flashcards
Reproductive System Cancers (4)
Cervical
Endometrial
Ovarian
Testicular
Cervical Cancer
Risk Factors
- HPV
- Multiple sexual partners
- Cigarettes
- Early age first intercourse
- Immunosuppression
- Hx of STD’s
- Long term contraceptives & HPV
- Age
- Unavailability/lack of screening
- Multiple live births
- Exposure to Diethylstilbestrol in utero
Cervical Cancer
Prevention
- Limit sexual partners
- Limit sexual encounters in teenage years
- Use of barrier contraceptives
- Education on safe sex practices
- HPV Vaccination for girls 11-12 yrs
Cervical Cancer
Screening
Pap smear +
HPV dna test
ACS Cervical Ca Screening recommendations
1) 21-29 yrs
2) 30-65 yrs
3) 66> yrs
4) Women w total hysterectomy
1) Pap smear every 3 yrs
2) HPV DNA test every 5 years or Pap every 3 years
3) Cease screening/ 3 or more consec - Pap/2 or more cons Pap and HPV test within last 5 yrs
- No screening needed
Cervical Ca
Common S/S
- Irregular bleeding (btwn menstrual periods or postcoital)
- Persistant vaginal discharge (blood-tinged or malodorous)
- Dyspareunia (pain during any penetration)
(not uncommon to present completely asymptomatic)
Cervical Ca
Late S/S
- Pelvic pain often radiating to legs
- Incontinence
- Weight loss
- Fatigue
Cervical Ca
Diagnostic tests
- Pelvic exam
- Cervical cytology
- Endocervical curettage
- Colposcopy
- HPV test
Cervical Ca
Staging
- PET scan
- CT scan
- Cytoscopy
- Chest radiograph
- US/MRI
- Laparoscopy
_____ Staging method used for Cervical Cancer
FIGO (International Federation of Gynecology and Obstetrics)
Figo Stages
1
1A1
1A2
- Carcinoma strictly confined to cervix
- Stromal invasion - 3mm deep - 7mm wide
- Stromal invasion 3-5mm deep - 7mm wide
Figo Stages
1B
1B1
1B1
- Clinical lesions confined to cervix or preclinical lesions > than stage 1A
- Lesions - 4cm
- Lesions >4cm
Figo Stages
II
III
IV
- Carcinoma beyond uterus but not on pelvic wall or lower third of vagina
- Carcinoma onto pelvic sidewall and lower third of vagina
- Into bladder/rectum/ other organs/mets
Cervical Ca
Tx
1) Early stage
2) Invasive disease
3) Advanced disease
4) Metatastic, Persistent, or Recurrent disease
1) Definitive Surgery
2) Combo Rt + Chemo
3) Chemo alone
4) Targeted therapy + Chemo
Cervical Ca surgical standard or care =
Radical Hysterectomy
Cervical Ca tx for Nonsurgical candidates
- Intracavitary Rt for early stage
- Brachytherapy + Pelvic RT + Platinum based chemo for advanced stages
Cervical Ca common metastatic sites
- Lungs
- Para-aortic LN
- Bones
Chemo for Cervical Ca
Fluorouracil +/- Mitomycin
Most common Gynecologic Ca in women in US
Endometrial
Endometrial Ca
Risk Factors
- HTN
- DM
- Obesity
- Increased estrogen exposure
- Tamoxifen
- Metabolic Snydrome
- Nulliparity
- Polycystic ovarian syndrome
- Endometrial hyperplasia
- Fam hx
Endometrial Ca
Poor prognosis =
Favorable prognosis =
= Overexpression of HER/neu gene
= high lvls of progesterone
Endometrial Ca
Prevention (6)
- Oral contraceptives
- Cigarette smoking (although not favorable)
- Pregnancy (bc of high progesterone lvls)
- Use of intrauterine devices
- breastfeeding
- Avoid high fat diets
- Increase physical activity
- Control HTN/DM
Best Screening Test for endometrial ca
Biopsy - Endometrial sampling
pap only detets occasionally and unreliably
Hallmark symptom of Endometrial Ca*
Irregular vaginal bleeding
Endometrial Ca
Late Sx asctd with ?
Pattern of mets
Endometrial Ca common sites of metastasis
Pelvic + Para-aortic LN
Common distant metastatic sites of Endometrial Ca
Lungs Liver Bones Brain Vagina
Endometrial Ca Staging systems (2)
FIGO
TNM
Endometrial Ca
Tx for Stage 1 & 2
- Surgery w/w LN sampling
- Postoperative vaginal brachytherapy
- RT alone
- Surgery w Postop chemo w/w RT for grade 3
Endometrial Ca
Tx for Stage 3, 4, Recurrent
- Surgery followed by chemo or RT
- Inoperable disease = Chemo + RT, Hormone or biologic therapy
- Paclitaxel, Doxorubicin, Cisplatin
- Clinical trials/combo therapy
Common Chemotherapies used for Endometrial CA (3)
Paclitaxel
Doxorubicin
Cisplatin
Ovarian Ca
Risk Factors
Which is most important?
- First degree relative w history of ovarian ca** (most important/BRCA12 mutations)
- Family hx of breast ca
- Endometriosis
- Nulliparity
- Use of talc
- Jewish descent
- Pelvic inflammatory disease
- Lynch syndrome
- Use of postmenopausal hormone therapy
- Obesity and tall height
Ovarian Ca
Prognostic indicators
- Younger age
- lower stage at dx with well differentiated tumor
- lower tumor burden
- lack of ascites at dx
- low residual disease following surgery
- serum cancer associated antigen (CA-125) - no relevance at time of dx but correlates with survival following chemo
Ovarian Ca
- Usually has _____ sx and diagnosed in ____ stage disease
vague
late
Ovarian Ca
Preventative measures
- Pregnancy
- Lactation
- Oophorectomy prophylactic
- Tubal ligation
- Use of oral contraceptives
- Annual health exam including bimanual rectovaginal exam
Ovarian Ca
Screening?
Not really available bc of anatomical position of ovaries, deep in pelvis
Ovarian Ca
Symptoms (4) vague
- Pelvic mass
- Abdominal pain (similar to appendicitis)
- Distention, bloating, constipation
- Vaginal bleeding
Ovarian Ca
GI symptoms
- Bloating
- Dyspepsia
- Early satiety
- Nausea
- Urinary symptoms
- Constipation
- Diarrhea
- Back pain
- Fatigue
Ovarian Ca
Gynecologic symptoms
- Abdominal distention/girth (caused by tumor or ascites)
- Pelvic pain
- Menstrual irregularities
- Vaginal bleeding
- Watery vaginal discharge
Ovarian Ca
Diagnostic tests
Definitive diagnosis?
- Pelvic examination including bimanual rectovaginal exam to palpate ovaries
- US if mass is suspected
- CT scan
- PET scan
- C-Xray
- MRI
- Serum CA-125 assay
Biopsy and microscopic examination of tissue
Ovarian CA
Stage 1
Stage 2
Stage 3
Stage 4
1) Tumor confined to ovaries or fallopian tubes
2) Extension into below pelvic brim or peritoneal cancer
3) Spread to peritoneum outside of pelvis and/or metastasis to retroperitoneal lymph nodes
4) Distant metastasis excluding peritoneal mets
Ovarian Ca
Early Stage Tx
1) 3 ectomy’s +
____ sampling + ____inspection and _____ of adjacent organs: peritoneal ____
followed by
2) Systemic _____ (____ based), intra____ chemo, or chemo with ____umab
3) _____ chemo followed by surgery
1) Hysterectomy Oophorectomy Omenectomy lymph node visual biopsy washings
2) chemo (platinum)
peritoneal
bevacizumab
3) neoadjuvant
Ovarian Ca
Advanced Stage disease tx
- Neoadjuvant chemo
- Hysterectomy, bilateral salpingo oophorectomy, omentectomy + debulking
- Intraperitoneal adjuvant chemo
- Adjuvant systemic chemo
- Clinical trials
Ovarian Ca
Recurrent Disease Tx
- _____ containing chemo
- (3)
- Platinum
- Bevacizumab, PARP inhibitors (targeted therapy), other targeted therapy w/w chemo
Ovarian Ca
Advanced disease palliative surgeries (4)
- Gastrostomy tube insertion
- Indwelling peritoneal catheter
- Pleural catheter
- Intestinal stenting
Testicular Ca
Prevention
Surgical repair of cryptorchidism prior to puberty
Crypto: when testes fail to descend from abdomen into scrotum
Testicular Ca
Risk Factors (3)
- Prior hx of testicular ca
- Cryptochidism
- Family hx
- 98% of Testicular Cancers histologically are
- Primarily dx in men ages __-__yrs
- Treatable/curable?
Germ cell tumors
- 15-35
- Highly treatable and curable
Testicular Ca
Favorable Prognostic Factors
- ___ stage and extent of disease at dx
- Low serum markers (3)
- Low
- Alpha fetoprotein (AFP), Lactase dehydrogenase (LDH), Beta-human chorionic gonadotropin (beta-hCG)
Testicular Ca
Symptoms
- Pea like, hard, painless swelling or enlargement of testis
- If pain is present, typically asctd w local hemorrhage within tumor
- Achiness in testis
- Heaviness in scrotum
- Dull low backache
- Asymmetry
Testicular Ca
Hormonal Symptoms (2)
- Breast tenderness or growth
- Loss of or reduced libido
Testicular Ca
Metastatic Symptoms (3)
- Back or chest pain
- Coughing
- SOB, hemoptysis
Testicular Ca
Diagnostic tests (2)
What is the imaging of choice?
- Physical exam, family hx
Ultrasound
Testicular Cancer
Seminoma vs Nonseminoma
Both are germ cell tumors, cells that make sperm
Seminoma: slower growing found in men in their 40-50’s, can spread to LN, very sensitive to RT
Nonseminoma: more common, grows more quickly
Testicular Ca
Tx for Low Grade Seminoma (less common, in men 40-50)
= Radical inguinal ____ + (3)
Orchiectomy +
- surveillance
- RT
- 1 or 2 doses of adjuvant carboplatin
Testicular Ca
Tx for Low Grade Nonseminoma (more common, grows more quickly than seminoma)
= Radical inguinal _____ + (3)
Orchiectomy
- surveillance
- nerve-sparing retroperitoneal LN dissection
- Adjuvant bleomycin, etoposide, cisplatin (BEP)
