Uterine/Ovary/Cervical CA, Gestational Trophoblastic Disease (docs) Flashcards
What cell type is involved in uterine cervical carcinoma?
epithelial neoplasm, usually squamous cell carcinoma
Epidemiology of uterine cervical carcinoma?
common
12,000 cases/yr
Pathogenesis of uterine cervical carcinoma?
sexually transmitted HPV, especially 16 and 18
*only a tiny fraction of those infected get CA, and only after a long premalignant phase (as long as 20 years)
Pathology of CIN-I?
koilocytotic atypia (large nuclei with a halo) correlated with viral replication
**now called LSIL
Pathology of CIN-II?
pleomorphic atypia
Pathology of CIN-III?
carcinoma in situ
Symptoms/signs of uterine cervical carcinoma?
none, until late, when it starts bleeding
Colposcopy results of CIN?
white patches after application of acetic acid
Prognosis of uterine cervical carcinoma?
stage I: 85% 5-year survival
stage II: 75% 5-year survival
stage III: <50% 5-year survival
Dx of uterine cervical carcinoma?
screen with pap
dx with biopsy
HPV E6 gene product induces:
rapid degradation of p53 by ubiquitin-dependent proteolysis
HPV E7 gene product complexes with:
Which causes:
hypophosphorylated active form RB protein
proteoysis of RB protein, removing its inhibition of S-phase entry (via binding E2F transcription factor)
Colposcopy results of Invasive-type cervical ca?
fungating or flat or ulcerated,
commonly with highly abnormal vascular patterns
Invasive cervical cancer occurs in patients ages:
40-45
CIN III occurs in patients around age:
30
Trx of HSIL (CIN-II/III)?
cryotherapy, laser, loop electrical excision procedure (LEEP), cone resection
Trx of invasive cervical cancer?
hysterectomy and pelvic lymph node dissection
Prevention of cervical cancer?
vaccine
Ovarian carcinoma arises from:
surface of the ovary
3 most common types of Ovarian carcinoma?
serous (75%)
endometrioid (10%)
mucinous (10%)
Epidemiology of Ovarian carcinoma?
common
slightly more common in whites
average age at dx = 63
*progressive four-fold rise in incidence between age 40-49 and age >70
Prognosis of Ovarian carcinoma?
depends on stage: 85% 5-year survival if confined to ovary, but 25% if spread
Treatment of Ovarian carcinoma?
surgery (excision if confined to ovary, “debulking” if spread)
+/- chemotherapy
Diagnosis of Ovarian carcinoma?
radiology (US or CT), then surgery with biopsy
When does dx of Ovarian carcinoma usually occur?
Commonly late, after already metastatic
Screening tests for Ovarian carcinoma?
none very good!
US, +/- serum CA-125
When are serum screening tests for Ovarian carcinoma commonly +?
when tumor = already stage 3
**half of patients with stage 1 ovarian cancer have a normal CA-125 level
Signs of Ovarian carcinoma?
*uncommon with early disease pelvic or abd mass abd ascites, tenderness groin LAD dec breath sound dullness to percussion over malignant pleural effusion
Symptoms of Ovarian carcinoma?
bloating abdominal enlargement urinary symptoms abd pain pelvic pressure \+++
In ovarian carcinoma, ___% have symptoms before diagnosis.
93
Pathology of Ovarian carcinoma?
> 60% distant metastases
~15% confined to 1’ at dx
typically 0.1-0.5 cm tumor nodules all over peritoneum and omentum
Spread of Ovarian carcinoma?
first to peritoneum
then other ovary, regional lymph nodes, liver, lungs, etc
Pathogenesis of Ovarian carcinoma?
accumulation of mutations in genes controlling cell proliferation (usually over many years)
Risk factors for Ovarian carcinoma?
- -age
- -high exposure to gonadotropins
- -high freq of ovulation (?)
- -few or no pregnancies
- -early menarche, late menopause
- -family history (*BRCA mutation)
- -smoking (mucinous type only)
Conditions (risk factors) related to ovarian cancer?
- -obesity (30% increased risk)
- -endometriosis (2.5 % lifetime risk)
types of endometrial carcinoma?
type 1 = endometrioid (grade 1 or 2) **80%
type 2 = endometrioid (grade 3), serous or mucinous (etc) **20%
Epidemiology of endometrial carcinoma?
US women have 2.6% lifetime risk
Average age at diagnosis = 61
Pathogenesis of endometrial carcinoma?
type 1 = estrogen-responsive
type 2 = not estrogen-responsive
Risk factors for type 1 endometrial carcinoma?
age obesity unopposed estrogen tamoxifen nulliparity DM HTN polycystic ovarian syndrome
Genetic abnormalities in endometrial carcinoma?
Loss of PTEN function = early event
loss of p53 = 1’ genetic defect in non-endometrioid endometrial CA
Pathology of endometrial carcinoma?
68% confined to uterus at dx
20% uterus + lymph nodes
8% + distant metastases
Location of recurrences of endometrial carcinoma?
vaginal vault > pelvis > abdomen or lungs
Symptoms of endometrial carcinoma?
abn uterine bleeding = cardinal symptom
Signs of endometrial carcinoma?
typically none (uterus is usually not enlarged on exam)
Dx of endometrial carcinoma?
can sometimes be made on cytology, but usually requires biopsy
Treatment of endometrial carcinoma?
type 1: hysterectomy alone
type 2: hysterectomy +/- chemotherapy +/- radiation
Prognosis of endometrial carcinoma?
cancer confined to uterus at dx = 96% 5-year survival
distant mets = 26% 5-year survival
Most recurrences of endometrial carcinoma are in the first ___ years
three
