What is the 5-yr survival rates (%) for the following Endometrial CA grades? ``` Grade I ( 50% solid) _____ ``` Localized ___ Regional ___ Distant___

``` Grade I ( 50% solid) 59% ``` Localized 95% Regional 67% Distant 16%

Upper Genital Tract Malignancies Flashcards by Lauren Lover

Unopposed estrogen can cause ___ CA
Frequent ovulation can cause __ CA
There is a Genetic predisposition for ___ and ___ CA

Endometrial CA
Ovarian CA
Fallopian tube / ovarian CA

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____ is the most frequent gyn CA in the US

Endometrial CA

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What is the median age for endometrial CA?

___% are dx < 45 y/o

61 y/o

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What are causes of unopposed estrogen?

OBESITY!
Nulliparity
Oligo-menorrhea
Late menopause
Estrogen-only meds
Estrogen-producing tumor
Tamoxifen

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What hereditary factors can put a pt at risk for endometrial CA?

Lynch II syndrome (uterus, ovary, breast, colon)

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How can you prevent endometrial CA?

Establish regular cycles
OCPs
Avoid estrogen-only replacement
Avoid obesity

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Is type I endometrial CA hormone dependent or independent? What grade(s) is it on histology?

Is it early/advanced stage?

Does it have a good/bad prognosis ?

Hormone-dependent
Endometroid grade I and II histology

Early stage

Good Prognosis

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Is type II endometrial CA hormone dependent or independent? What grade(s) is it on histology?

Is it early/advanced stage?

Does it have a good/bad prognosis ?

No hormonal influences
endometroid grade III, papillary serous and clear cell histology

Advanced stage

Poor prognosis

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What are the most common pathology types for endometrial CA? Percentages?

Adenocarcinoma - 60%

Adenoacanthoma - 22%

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What is the 5-yr survival rates (%) for the following Endometrial CA grades?

Grade I (<5% solid) \_\_\_\_
Grade II (5-49% solid) \_\_\_\_\_
Grade III (>50% solid) \_\_\_\_\_

Localized ___
Regional ___
Distant___

Grade I (<5% solid)	  80%
Grade II (5-49% solid)	73%
Grade III (>50% solid)	59%

Localized 95%
Regional 67%
Distant 16%

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What are sx of endometrial CA?

What signs are rarely present?

Postmenopausal bleeding
Brownish discharge
Irregular bleeding and spotting

Rarely signs of dissemination such as pain, mass, ascites

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What age is endometrial CA most common?

60% >80 y/o

28% 70-79 y/o

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How do you dx endometrial CA?

Bx
US
Hysteroscopy
D and C

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What is included in the pre-tx w/u for endometrial CA? (imaging, etc)

Mainly assess risk for surgery

CXR
CT scan
MRI if surgery not possible

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How do you tx endometrial CA?

TAH/BSO +/- staging
Radiation to the vaginal cuff
External radiation
Chemotherapy
Progestational agents

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What are the benefits of pelvic lymphadenectomy?

Detection of nodal metastasis

Individualized tx planning

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What are the cons of pelvic lymphadenectomy? (FYI)

Risk of surgery,
Risk of lymphedema, lymphocyst
No definite survival benefit

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What are the 3 types of uterine sarcomas? % distribution of each?

Leiomyosarcoma (16%)
Endometrial stromal sarcoma (44%)
Mixed mesodermal sarcoma (40%)

T/F: Uterine sarcomas are common

F: they are RARE

Are Asians/Whites/African Americans more likely to have uterine sarcoma?

African American women

Sx of uterine CA are similar to those of ___ CA

Endometrial CA

Uterine sarcomas are ___ tumors w/ a high risk of ____.
There is a ___ response rate to tx.
Stage 1 dz has a survival rate of ___%

aggressive; distant metastasis
Low
50%

What are the types of ovarian tumors? (x8+)

Brenner
Endometrioid
Mucinous

Serous
Clear cell
Undifferentiated
Mixed (Types: Benign/Borderline/Malignant) 
Mixed mesodermal tumors

(BEM SCUMM)

Fallopian tube CA originates mainly in the ____.
Tissue transfer to the ovary at time of ovulation can cause ___ CA.
Fallopian tube CA is clinically similar to ___ CA.

fimbriae
ovarian
ovarian

Adenocarcinoma of the peritoneum originates from ___ and ____. Clinically similar to _____ CA, the largest tumor volume is often in the ____.

endometriosis endosalpingiosis ovarian omentum

Ovarian CA causes __% of gyn CA, but cause __% of gyn CA deaths. Median age is __ y/o, ___% < 45 y/o

23% 47% 63 y/o 11%

What are the RF for ovarian CA? (x8)

FHx, frequent ovulation, low parity, caucasian, high fat/low fiber diet, talc exposure, living in northern countries, high SES

What is your risk of ovarian CA if you have the BRCA 1 mutation? (%) What other malignancies may you be at risk for? (%)

BRCA 1: 40-46% | Breast CA: 50-85%

What is your risk of ovarian CA if you have the BRCA 2 mutation? What other malignancies may you be at risk for?

``` 10-20% Breast CA (40-85%) ```

What is your risk of ovarian CA if you have lynch syndrome? | What other malignancies may you be at risk for?

9-12% Colon CA 30-54% Uterine CA 40-60%

Oral contraceptiive can reduce risk of ovarian CA in pts with ____, ____, or the ____.

Nulliparity (after 5 yrs of use) Positive FHx (after 10 yrs of use) BRCA mutation

T/F: General screening for ovarian CA is not recommended due to low prevalence

If you have a (+) FHx for ovarian CA: what age should you be screened and what are the screening exams? If a pt has Hereditary Ovarian CA, what age should they be screened? What are the screening exams?

Age 30-35 y/o - pelvic exam - CA 125 - US Age 25: (as above) - consider BSO or at least salpingectomy

What are ovarian CA warning signs?

Ill-defined GI complaints Early satiety Abdominal distention and bloating (For >12 days/mo) Persistent pelvic pain in a postmenopausal pt

How do you dx ovarian CA?

``` General PE Pelvic exam CA 125 level, OVA 1, CEA, Pelvic US CT abdomen and pelvis CXR ```

what are the 2 types of low malignant potential ovarian tumors?

Epithelial "borderline" tumors | Stromal

If ovarian CA is suspected, surgery (mainstay) allows for __ and ___

``` Dx Surgical staging (ctyology, peritoneal bx, lymphadenectomy) ```

Tumor Reductive Surgery can be used in ovarian CA and If adequate, it can Lead to ____

Survival benefit

What are post-op tx for ovarian CA?

Systemic chemotherapy | Intraperitoneal therapy

Intra-peritoneal chemotherapy is delivered through an ___ port. What are the pros? Cons?

IP Pros: improved overall survival Cons: difficult to administer, more side effects

PARP Inhibitors have the best effect if the pt has a germ line or tumor ___ mutation

BRCA

What are prognostic factors for ovarian CA?

Time to recurrence | Response to platin compounds

What is the 5 yr survival rate for the following with ovarian CA? (FYI) localized ___ %pts ___ 5 yr survival regional ___ %pts ___ 5 yr survival distant ___ %pts ___ 5 yr survival

localized: 15%; 91% regional: 17%; 72% distant: 61%; 27%