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OCN ONS Bundle > Reproductive System Cancers > Flashcards

Reproductive System Cancers Flashcards

1
Q

Reproductive System Cancers (4)

A

Cervical
Endometrial
Ovarian
Testicular

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2
Q

Cervical Cancer

Risk Factors

A
  • 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
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3
Q

Cervical Cancer

Prevention

A
  • 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
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4
Q

Cervical Cancer

Screening

A

Pap smear +

HPV dna test

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5
Q

ACS Cervical Ca Screening recommendations

1) 21-29 yrs
2) 30-65 yrs
3) 66> yrs
4) Women w total hysterectomy

A

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

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6
Q

Cervical Ca

Common S/S

A
  • 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)

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7
Q

Cervical Ca

Late S/S

A
  • Pelvic pain often radiating to legs
  • Incontinence
  • Weight loss
  • Fatigue
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8
Q

Cervical Ca

Diagnostic tests

A
  • Pelvic exam
  • Cervical cytology
  • Endocervical curettage
  • Colposcopy
  • HPV test
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9
Q

Cervical Ca

Staging

A
  • PET scan
  • CT scan
  • Cytoscopy
  • Chest radiograph
  • US/MRI
  • Laparoscopy
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10
Q

_____ Staging method used for Cervical Cancer

A

FIGO (International Federation of Gynecology and Obstetrics)

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11
Q

Figo Stages

1
1A1
1A2

A
  • Carcinoma strictly confined to cervix
  • Stromal invasion - 3mm deep - 7mm wide
  • Stromal invasion 3-5mm deep - 7mm wide
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12
Q

Figo Stages

1B
1B1
1B1

A
  • Clinical lesions confined to cervix or preclinical lesions > than stage 1A
  • Lesions - 4cm
  • Lesions >4cm
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13
Q

Figo Stages

II
III
IV

A
  • 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
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14
Q

Cervical Ca

Tx

1) Early stage
2) Invasive disease
3) Advanced disease
4) Metatastic, Persistent, or Recurrent disease

A

1) Definitive Surgery
2) Combo Rt + Chemo
3) Chemo alone
4) Targeted therapy + Chemo

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15
Q

Cervical Ca surgical standard or care =

A

Radical Hysterectomy

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16
Q

Cervical Ca tx for Nonsurgical candidates

A
  • Intracavitary Rt for early stage

- Brachytherapy + Pelvic RT + Platinum based chemo for advanced stages

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17
Q

Cervical Ca common metastatic sites

A
  • Lungs
  • Para-aortic LN
  • Bones
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18
Q

Chemo for Cervical Ca

A

Fluorouracil +/- Mitomycin

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19
Q

Most common Gynecologic Ca in women in US

A

Endometrial

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20
Q

Endometrial Ca

Risk Factors

A
  • HTN
  • DM
  • Obesity
  • Increased estrogen exposure
  • Tamoxifen
  • Metabolic Snydrome
  • Nulliparity
  • Polycystic ovarian syndrome
  • Endometrial hyperplasia
  • Fam hx
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21
Q

Endometrial Ca

Poor prognosis =
Favorable prognosis =

A

= Overexpression of HER/neu gene

= high lvls of progesterone

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22
Q

Endometrial Ca

Prevention (6)

A
  • 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
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23
Q

Best Screening Test for endometrial ca

A

Biopsy - Endometrial sampling

pap only detets occasionally and unreliably

24
Q

Hallmark symptom of Endometrial Ca*

A

Irregular vaginal bleeding

25
Q

Endometrial Ca

Late Sx asctd with ?

A

Pattern of mets

26
Q

Endometrial Ca common sites of metastasis

A

Pelvic + Para-aortic LN

27
Q

Common distant metastatic sites of Endometrial Ca

A 
Lungs 
Liver 
Bones 
Brain
Vagina
28
Q

Endometrial Ca Staging systems (2)

A

FIGO

TNM

29
Q

Endometrial Ca

Tx for Stage 1 & 2

A
  • Surgery w/w LN sampling
  • Postoperative vaginal brachytherapy
  • RT alone
  • Surgery w Postop chemo w/w RT for grade 3
30
Q

Endometrial Ca

Tx for Stage 3, 4, Recurrent

A
  • Surgery followed by chemo or RT
  • Inoperable disease = Chemo + RT, Hormone or biologic therapy
  • Paclitaxel, Doxorubicin, Cisplatin
  • Clinical trials/combo therapy
31
Q

Common Chemotherapies used for Endometrial CA (3)

A

Paclitaxel
Doxorubicin
Cisplatin

32
Q

Ovarian Ca

Risk Factors

Which is most important?

A
  • 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
33
Q

Ovarian Ca

Prognostic indicators

A
  • 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
34
Q

Ovarian Ca

  • Usually has _____ sx and diagnosed in ____ stage disease
A

vague

late

35
Q

Ovarian Ca

Preventative measures

A
  • Pregnancy
  • Lactation
  • Oophorectomy prophylactic
  • Tubal ligation
  • Use of oral contraceptives
  • Annual health exam including bimanual rectovaginal exam
36
Q

Ovarian Ca

Screening?

A

Not really available bc of anatomical position of ovaries, deep in pelvis

37
Q

Ovarian Ca

Symptoms (4) vague

A
  • Pelvic mass
  • Abdominal pain (similar to appendicitis)
  • Distention, bloating, constipation
  • Vaginal bleeding
38
Q

Ovarian Ca

GI symptoms

A
  • Bloating
  • Dyspepsia
  • Early satiety
  • Nausea
  • Urinary symptoms
  • Constipation
  • Diarrhea
  • Back pain
  • Fatigue
39
Q

Ovarian Ca

Gynecologic symptoms

A
  • Abdominal distention/girth (caused by tumor or ascites)
  • Pelvic pain
  • Menstrual irregularities
  • Vaginal bleeding
  • Watery vaginal discharge
40
Q

Ovarian Ca

Diagnostic tests

Definitive diagnosis?

A
  • 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

41
Q

Ovarian CA

Stage 1
Stage 2
Stage 3
Stage 4

A

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

42
Q

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

A 
1) Hysterectomy 
Oophorectomy 
Omenectomy
lymph node 
visual 
biopsy 
washings

2) chemo (platinum)
peritoneal
bevacizumab

3) neoadjuvant

43
Q

Ovarian Ca

Advanced Stage disease tx

A
  • Neoadjuvant chemo
  • Hysterectomy, bilateral salpingo oophorectomy, omentectomy + debulking
  • Intraperitoneal adjuvant chemo
  • Adjuvant systemic chemo
  • Clinical trials
44
Q

Ovarian Ca

Recurrent Disease Tx

  • _____ containing chemo
  • (3)
A
  • Platinum

- Bevacizumab, PARP inhibitors (targeted therapy), other targeted therapy w/w chemo

45
Q

Ovarian Ca

Advanced disease palliative surgeries (4)

A
  • Gastrostomy tube insertion
  • Indwelling peritoneal catheter
  • Pleural catheter
  • Intestinal stenting
46
Q

Testicular Ca

Prevention

A

Surgical repair of cryptorchidism prior to puberty

Crypto: when testes fail to descend from abdomen into scrotum

47
Q

Testicular Ca

Risk Factors (3)

A
  • Prior hx of testicular ca
  • Cryptochidism
  • Family hx
48
Q
  • 98% of Testicular Cancers histologically are
  • Primarily dx in men ages __-__yrs
  • Treatable/curable?
A

Germ cell tumors

  • 15-35
  • Highly treatable and curable
49
Q

Testicular Ca

Favorable Prognostic Factors

  • ___ stage and extent of disease at dx
  • Low serum markers (3)
A
  • Low

- Alpha fetoprotein (AFP), Lactase dehydrogenase (LDH), Beta-human chorionic gonadotropin (beta-hCG)

50
Q

Testicular Ca

Symptoms

A
  • 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
51
Q

Testicular Ca

Hormonal Symptoms (2)

A
  • Breast tenderness or growth

- Loss of or reduced libido

52
Q

Testicular Ca

Metastatic Symptoms (3)

A
  • Back or chest pain
  • Coughing
  • SOB, hemoptysis
53
Q

Testicular Ca

Diagnostic tests (2)

What is the imaging of choice?

A
  • Physical exam, family hx

Ultrasound

54
Q

Testicular Cancer

Seminoma vs Nonseminoma

A

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

55
Q

Testicular Ca

Tx for Low Grade Seminoma (less common, in men 40-50)

= Radical inguinal ____ + (3)

A

Orchiectomy +

  • surveillance
  • RT
  • 1 or 2 doses of adjuvant carboplatin
56
Q

Testicular Ca

Tx for Low Grade Nonseminoma (more common, grows more quickly than seminoma)

= Radical inguinal _____ + (3)

A

Orchiectomy

  • surveillance
  • nerve-sparing retroperitoneal LN dissection
  • Adjuvant bleomycin, etoposide, cisplatin (BEP)

OCN ONS Bundle (11 decks)

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